As thousands of Oklahomans have been locked out of SoonerCare, the state’s Medicaid program, many are turning to the federal insurance market for a new plan.
But in Oklahoma City, many have turned to direct primary care programs, which connect them directly to providers through monthly subscriptions, forgoing insurance companies altogether.
This works for many families, but others might feel more comfortable with traditional health insurance.
Starting Nov. 1, an insurance company will be the first in Oklahoma to bring direct primary care coverage to residents of the OKC metro area on the market.
Taro Health, based in Maine, will begin by offering coverage to residents of Oklahoma, Cleveland and Canadian counties, with hopes of expanding, according to co-founder Jeff Yuan.
It includes a regular health insurance plan, in addition to access to a direct primary care physician in Oklahoma City.
What is direct primary care?
Direct primary care, or DPC, began before insurance payments, but the 21st century direct primary care model emerged in the late 2000s with the founding of Qliance by Dr. Garrison Bliss in Seattle.
Under this model, patients spend more time with their doctors and can see their provider the same or next day due to fewer patients, said Dr. Kyle Rickner, founder of Primary Health Partners.
Rickner said the typical caseload for his doctors is 600 to 800 patients. In traditional primary care models, the number of patients is often between 2,000 and 3,000, Rickner said.
A busy day for a direct primary care physician involves seeing eight to 10 patients, he said.
“The doctor is never in a hurry; he doesn’t care how many people he sees per day,” Rickner said.
With the existing base of providers and patients in the metro, Yuan said Oklahoma was the perfect place to start growing the business.
For those who sign up for Taro Health’s insurance plan, access to a direct primary care physician is included rather than the patient having to pay the monthly fee.
“Our goal is we’re really trying to focus on people’s health instead of just being there when you’re sick,” Yuan said. “This means that if people want to spend their hard-earned money paying sky-high health insurance premiums, they should at least get preventative and primary care with some peace of mind.”
Primary Health Partners, which started in Yukon and is about to open its 11th clinic in the metro area, is partnering with Taro in hopes of giving more people the opportunity to benefit from direct primary care. In total, 26 suppliers work for the company, Rickner said.
What can I do if I no longer receive SoonerCare?
After the public health emergency ended, the Oklahoma Health Care Authority in March began screening SoonerCare members and disenrolling those who are no longer eligible for coverage.
For Oklahomans included in this mass disenrollment, OHCA estimated that 300,000 adults and children would be removed from SoonerCare during a nine-month renewal process. There is a special enrollment period on the Affordable Care ActMarketplace from March 31, 2023 to July 31, 2024.
If you have been excluded from SoonerCare, you have several options for obtaining coverage, including with a provider direct care plan.
Anyone eligible for the Healthcare.gov insurance marketplace and living in Oklahoma, Canada, or Cleveland counties can choose Taro Health as their provider.
Taro offers three different plans, bronze, silver and gold, which differ in terms of deductible amount, monthly payment and the cost of things like labs, medications, x-rays and specialists.
For those who can’t get insurance through Marketplace because they have insurance through their employer, Primary Health Partners offers a $99 per month plan. Children under 25 can be added to an adult membership for $49 per month.
Direct Primary Care of Oklahoma offers similar prices in Edmond, as does The Little DPC in Oklahoma City.
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