Questions about Coverage

We take tremendous pride in the compassionate attention we provide for senior citizens and individuals struggling with chronic illness or debilitating injury. To help us do so, we now accept Original Medicare, which is easily and commonly confused with Medicare Advantage. Click here to learn about the differences in these categories of Medicare.

For all non-Medicare patients, we are proud to offer reasonable and transparent pricing for personalized, attentive physician visits.

Because we are out-of-network for all commercial health insurers (such as Aetna, Blue Cross Blue Shield, Harvard Pilgrim, Tufts Health, and others), we are unable to provide referrals or pre-authorizations for closed-network plans. Please check the rules of your insurance plan to determine whether you require an “in-network” Primary Care Provider.

Why did we make the change from being a strict Direct Primary Care (DPC) practice to accepting Medicare?

After careful examination of our practice where a large portion of our care is delivered to the elderly, chronically ill, or homebound – that is, Medicare beneficiaries – it became clear that re-enrolling for participation with Medicare is the best way for us to sustainably stay open and accessible.  We have been active with Medicare since October 2019, shifting us to a model known as “DPC Hybrid”.

Will ThriveAPC begin accepting other forms of insurance?  What about MassHealth?

Medicare Part B (the part that covers doctors’ services and outpatient care) is the only health plan through whom Thrive Adult Primary Care will process third-party payment for the foreseeable future. We will continue offering our services to patients without Medicare through Direct Care (private pay) options. For patients with Medicare Advantage plans who wish to benefit from our physician-led services, we can provide superbills (Medicare claim forms) to seek reimbursement from your health insurer, but payment will be due at the time of the visit.

Is my Medicare Advantage plan accepted at Thrive Adult Primary Care?

Medicare Advantage plans are different from what is commonly referred to as “straight” Medicare, or Medicare Part B. These Advantage plans are managed by commercial health insurers such as Aetna, Blue Cross Blue Shield, Harvard Pilgrim, Tufts Health, and others. We unfortunately cannot bill these plans directly for your visits, but we are able to provide a detailed claim form, also known as a “superbill”, which you can submit to your Advantage plan to be reimbursed for the cost of your visit.

Can I pay for care using an HSA, HRA, or FSA?

You can absolutely use funds from a Health Savings Account (HSA), Health Reimbursement Arrangement (HRA), or Flexible Spending Account (FSA) for services rendered by Thrive Adult Primary Care. Please feel free to contact our office for more details on how we work with funds you may have set aside for healthcare spending.

Do I have to “become a member” to be a patient at Thrive Adult Primary Care?

There is NO need for a monthly membership to receive care at ThriveAPC.

Medicare patients are welcome to come to the office on a visit-by-visit basis, owing no more than the standard visit co-pays.

Individual visits for non-Medicare patients are priced sensibly and transparently. Our Pay-As-You-Go (PAYG) options are available to ALL patients without Medicare, just check out our Price List for more information. These visits are intended to address specific, short-term problems, or provide face-to-face time with a physician for discussions about your health.

If you have conditions treated by prescription medications that require ongoing refills, a membership is strongly advised. For non-Medicare patients without memberships, prescriptions are only written for a supply lasting a maximum of 30 days following a Pay-As-You-Go visit.

Are my costs at ThriveAPC tax deductible?

Any money you spend out-of-pocket (not covered by a health plan or dedicated healthcare spending account) may be counted towards healthcare expenditures, which may be tax-deductible depending on the state where you work and/or live. We are more than happy to provide invoices for your transactions with us, either on paper or by email, to help you keep track of medical costs incurred with our practice.

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