Medicare & Insurance at Segno
Understanding Your Coverage and Your Choices
One of the most important things I want patients to understand is that having health insurance and having access to excellent primary care are not necessarily the same thing.
Segno offers comprehensive, evidence-based internal medicine through a direct primary care membership. Because we don't bill insurance for the primary care services included in your membership, our relationship can focus on your medical needs rather than the requirements of insurance reimbursement.
But insurance still matters. And understanding how your coverage works alongside Segno is important.
Original Medicare vs. Medicare Advantage
Although both provide Medicare coverage, they work differently.
Original Medicare is administered by the federal government. Patients can generally see any physician or hospital that accepts Medicare, without being restricted to a particular provider network.
Medicare Advantage (Part C) plans are offered by private insurance companies approved by Medicare. They often include additional benefits, such as dental, vision, hearing, or prescription drug coverage.
For some patients, Medicare Advantage is a good fit. But there are tradeoffs worth understanding.
Medicare Advantage plans may:
Limit which physicians, specialists, and hospitals are covered through provider networks.
Require referrals or prior authorization for certain services.
Have different out-of-pocket costs depending on where and how care is received.
Require additional coordination when care is ordered by a physician outside the plan's network.
These differences can become particularly important when a patient develops a serious illness or needs complex medical care.
Can I Join Segno If I Have Medicare?
Yes. Segno welcomes Medicare beneficiaries.
Beginning January 1, 2027, I plan to practice as a physician who has opted out of Medicare.
Medicare beneficiaries who join Segno will be required to sign a private contract acknowledging that Medicare will not reimburse the physician services covered by that contract.
You do not have to give up Medicare to join Segno.
Your Medicare coverage may continue to pay for eligible services received from other providers, including specialists, hospitals, and diagnostic facilities, according to your plan's rules.
What If I Have Medicare Advantage?
Having Medicare Advantage does not prevent you from joining Segno.
However, some plans may require referrals, authorizations, or orders from physicians within their network before covering certain services.
This can create additional administrative challenges when coordinating care.
Before deciding on or changing your Medicare Advantage plan, it's important to understand how the change could affect your specialists, prescriptions, hospital coverage, and other benefits.
I do not recommend changing your insurance solely to join Segno without carefully reviewing your individual circumstances.
Can Direct Primary Care Save Money?
For many patients, yes.
Patients with high-deductible commercial insurance plans may pay substantial amounts out of pocket for routine care, laboratory testing, and imaging.
Direct primary care provides a predictable monthly fee for covered primary care services. Many DPC practices also help patients access transparent cash prices for laboratory testing, imaging, and medications. This is something I am actively working on for Segno patients, which I hope to have in place by opening.
Sometimes those prices are lower than what patients would pay using insurance.
At Segno, my goal is to help patients understand their options and make informed decisions about the cost of their care.
However, direct primary care does not replace health insurance, and savings are not guaranteed. Cash payments generally do not count toward insurance deductibles or out-of-pocket maximums.
My Philosophy
I believe patients deserve to understand not only their medical conditions and treatment options, but also the financial and administrative barriers that can affect their care.
My goal isn't to tell you which insurance plan to choose.
It's to help you make informed decisions, understand your options, and receive thoughtful medical care without unnecessary obstacles.
Real medicine. A better way to experience it.
This page provides general educational information and is not individualized insurance advice. Medicare and Medicare Advantage benefits, referral requirements, and coverage rules vary. Patients should confirm details with their insurer or a qualified Medicare counselor before changing coverage.