Healthcare memberships are becoming more common, and while patients should be happy about this (we’ll explain why it is a great healthcare option), many don’t understand how they work or even what they are.
If you have, or have ever looked into, a gym membership, you already know a little bit about how membership-based healthcare works!
And while not every membership or every gym is going to work for you, the same is true of healthcare memberships, so understanding how membership based healthcare compares to traditional insurance-based healthcare is a good place to start and understand if it’s worth it for you.
Quick Links:
- What Is Membership-Based Healthcare?
- How Is Membership-Based Healthcare Different From Traditional Primary Care?
- Does a Healthcare Membership Replace Health Insurance?
- How Membership-Based Healthcare Can Make Healthcare Costs More Predictable
- How a Membership Makes Routine and Preventative Care Easier
- Is Membership-Based Healthcare Helpful for Acute Care?
- Who May Benefit Most From a Healthcare Membership?
- Questions to Ask Before Joining a Healthcare Membership
What Is Membership-Based Healthcare?
Membership-based healthcare is similar to having a gym membership. For a set fee each month, you’re entitled to regular access to a range of services. Most people are used to paying a separate fee or copay every time they visit their doctor, but with most membership models, those costs are covered, and routine visits and access to your doctor are included whenever you need them.
Services often include routine exams, preventive care, appointments to discuss concerns, follow-ups, acute care (for sudden illness), and reviews of lab and test results. Because services vary by clinic, it’s worth checking before joining.
Membership-based healthcare often aims to make access to doctors easier and encourage communication and discussion. When patients don’t have to pay for every visit, they often make more frequent appointments to ask questions and get advice regarding health concerns and healthy living.
How Is Membership-Based Healthcare Different From Traditional Primary Care?
Most traditional primary care relies on health insurance. So, when you go see your doctor, services are billed to your insurance or paid out of pocket, depending on your insurance.
Healthcare costs might include a copay, a deductible, or costs for services not covered by insurance. Because insurance typically pays only for specific services, appointments usually focus only on the issue your insurance can be billed for. That leaves little time to discuss other concerns. That takes another appointment.
With membership-based healthcare, patients pay a predictable monthly fee that’s not tied to a specific service or ailment/concern. This means appointments can run longer and conversations can be in-depth about pressing concerns that prompted the appointment, as well as other health factors or goals.
But the difference isn’t just the bill; it also significantly changes how patients view and use primary care. When your visits don’t generate a bill or require a specific need, you may find that your relationship with your care provider changes. You have more time to ask questions, discuss health trends and history, and stay current on preventive care.
Does a Healthcare Membership Replace Health Insurance?
This is often the second question patients ask: Do I still need health insurance? Membership-based healthcare does not replace health insurance. Memberships usually cover primary and acute care as defined by the clinic; insurance should still help cover expenses outside that scope.
For example, insurance would still be helpful for:
- ER visits and hospital stays
- Specialists
- Surgeries
- Prescription coverage
- Advanced imaging
- Care from other doctors outside the clinic
Most patients use healthcare memberships to supplement insurance, especially if they have a high-deductible plan. Rather than paying out of pocket for every visit (especially when visits’re increasingly difficult to schedule), patients can access primary and preventive care to stave off more costly problems that can arise when care is neglected.
Many people still find insurance helpful for covering the costs of more expensive healthcare needs or unexpected emergencies. Understanding what membership includes can help you find something that works best with your existing healthcare coverage.
How Membership-Based Healthcare Can Make Healthcare Costs More Predictable
One fee. That’s it. As long as the care you need is covered by the membership, there are no surprises when you check out, and it doesn’t matter what you discuss with your doctor, whether that’s your allergies, your cold, a nagging pain in your hip, or more.
The individual charges and multiple appointments for multiple concerns are replaced with a consistent monthly fee and no insurance company parameters for your appointments. Just you and your doctor talking about your health.
While there are costs outside the membership, such as labs, imaging, prescriptions, and specialists, the main goal is to make regular, routine visits transparent, predictable, and accessible. With greater access to your primary care doctor, you can hopefully work to prevent avoidable and more costly health concerns later.
How a Membership Makes Routine and Preventative Care Easier
With insurance and traditional healthcare, many patients put off doctor visits due to cost. Instead, they turn to friends, family, WebMD, and other resources to try to diagnose or develop a plan. This can be misguided and, sometimes, dangerous. It is important to have a primary care doctor who knows you and knows your health history. With a healthcare membership, our routine visits, questions, concerns, and routine needs are covered, so financial uncertainty is limited.
This access helps many patients stay current with routine exams and have time to discuss healthcare needs, like screenings, while monitoring existing concerns. Small problems or concerns are managed before they become more costly, bigger problems.
In addition to improving the level of and access to care, memberships often help build stronger doctor-patient relationships. Regular visits, especially those lasting longer than 10-15 minutes and allowing you to cover health history, concerns, and goals, create a more personalized healthcare experience. With all this knowledge, your doctor is better prepared to “prescribe” proactive steps you can take to support good health.
Is Membership-Based Healthcare Helpful for Acute Care?
But what about acute care? What about sudden illness? Minor injuries? Infections? Often, most patients go to an urgent care clinic or the ER to handle these. With your healthcare membership, visits to address these are covered.
Patients may be less inclined to delay care or head to the ER for something manageable with their regular doctor. Further, a doctor with intimate knowledge of your health history and goals may make an acute visit more personal, calming, and efficient. They can better evaluate the severity of the immediate concern based on context, including medications and existing conditions. They can then provide care or make an appropriate referral.
That said, a healthcare membership does not replace the emergency room or a hospital visit when necessary. Severe symptoms like difficulty breathing or significant injuries require immediate medical attention best delivered by an emergency department or paramedics via 911.
Who May Benefit Most From a Healthcare Membership?
Healthcare memberships can benefit anyone looking for more consistent care and lower costs. Both individuals and businesses that want to improve their health or their employees’ health by providing regular access to doctors can benefit.
However, memberships can be very helpful for the following people:
People who value long-term relationships with their physician: There’s a real value to having a doctor who knows you well over time. A strong relationship is built over time through conversation and an understanding of your health history, concerns, and goals. Research even suggests that this relationship can improve functional health.
People who put off care due to costs: Many of us have delayed care because of fears of unpredictable or rising healthcare costs, especially when multiple appointments are needed. A predictable monthly fee makes all of these decisions easier.
People managing ongoing or chronic health concerns: Monitoring health concerns over time often requires regular appointments. Improved access supports medication management and adjustments to your care plan.
People who value time with their doctor: As discussed above, insurance and insurance billing sometimes limit what can be covered during a single appointment. This limits conversation, questions, education, and collaborative planning.
People with high-deductible insurance plans: These plans often lead to high out-of-pocket costs, even for routine care. A healthcare membership provides access to routine care while keeping insurance for major medical coverage.
People juggling many responsibilities or obligations: One of the biggest struggles for patients is scheduling, especially when there are multiple concerns. This often means multiple appointments, and if your schedule is tight, it becomes increasingly difficult to get the care you need. A membership lets you address your needs in a single visit: you have time and no third-party constraints.
Small business owners and their employees: As a small business owner, one of your best resources is your employees. Better access to primary care, especially with a high-deductible plan, ensures your employees feel cared for not only by the business but also by their doctor.
People interested in preventative and naturopathic care: Naturopathic care focuses on the whole person, and it’s hard to do that if visits are compartmentalized, meaning limited to one concern at a time. A membership supports ongoing holistic care, where patients can discuss concerns openly with doctors, and doctors can potentially see connections among them that help them address a patient’s health more effectively.
Additionally, research suggests that multiple visits with a primary care physician can improve preventative care.
In short, anyone interested in their long-term health and in preventing the kinds of illness and disease that come with delayed care or ignoring health signals could benefit from a healthcare membership.
So, is it worth it for you? The answer is as individual as healthcare itself, but if any of the above factors are speaking to you, then it’s time to start investigating!
Questions to Ask Before Joining a Healthcare Membership
If a healthcare membership is starting to sound like a good idea, we’d agree. It’s why we built our clinic around this model. However, not all memberships are the same!
As a patient, it’s important to understand what the membership provides, so here are a few questions to ask as you decide which membership is best for you, your family, or your employees.
1. Which services are covered by the monthly fee? You’ll want to know if routine exams, preventative care, acute visits, regular communication, and which treatments are included.
2. Which services require additional payments? Memberships don’t always cover everything. For many practices, additional fees apply to labs and imaging, prescriptions, some procedures, supplements, or specialists.
3. How easily can I see my doctor when I need something? Ask about appointment availability, office wait times, and communication standards and expectations.
4. How does the clinic work with outside providers? Some situations may call for a referral or a recommendation to seek hospital care. You’ll want to understand how your doctor will communicate and work with those individuals, especially regarding a treatment plan.
5. What are the membership terms? Are there enrollment fees? Minimum commitments? Cancellation terms? Do unused services or appointments carry over? Are there family plans? Business plans?
While healthcare memberships can be beneficial and an amazing addition to your healthcare coverage, understanding what you’re signing up for and how to take advantage of all of the benefits the membership includes may require you to ask questions.
Regardless of your health goals, one thing is true: meeting more regularly with your care team can help improve outcomes. Healthcare memberships can make primary and preventive care more accessible.
It may not be the right choice for everyone, but if you’re looking to shape your healthcare needs over time and keep costs predictable, a healthcare membership may be what you’re looking for.
We welcome you to review Canby Clinic’s healthcare membership and, as always, reach out to our team with more questions or to schedule a free 15-minute “Meet the Doc” appointment. You’ll speak directly to one of our naturopathic doctors and determine whether a healthcare membership is a good fit for you!