Starting this fall, Cumberland County residents will have the option of purchasing a new type of health insurance on the Affordable Care Act marketplace that blends traditional insurance and direct primary care.
Taro Health – a new insurer based in Maine – is offering a potentially first-in-the-nation insurance model that is being teed up for next year. The company’s rates are approved, but plan filings have yet to be finalized by the Maine Bureau of Insurance, so the plans are not yet approved to sell insurance for 2023.
The insurer is targeting about 5,000 people who choose to pay their doctors directly and forgo traditional insurance, a model called direct primary care. Under direct primary care, patients pay out of pocket for routine doctor visits and the type of care that can be done in a doctor’s office, such as diagnosing and treating mild illnesses, some screenings, blood tests and annual physicals.
People who want to switch to a direct primary care doctor would also be eligible for Taro Health plans.
By eliminating insurance paperwork for routine care, direct primary care advocates say, doctors can focus more time on patients and pass on cost savings from not having to process insurance claims.
But that model flounders when patients need specialized care, such as for broken bones, cancer or rare diseases. If they hadn’t purchased insurance in addition to paying direct primary care fees, they would be on the hook for the cost of expensive hospital visits and specialty care. The Taro Health plan is a hybrid of conventional insurance and direct primary care. Members pay a monthly premium for traditional health insurance options and a network of 12 physicians who participate as direct primary care providers.
A COMBINING OF CONCEPTS
“There’s a combining of concepts,” Jeff Yuan, a co-founder of