The cost of health insurance is becoming increasingly unaffordable. And with many Affordable Care Act marketplace subsidies set to end, coverage is about to get even more expensive for more than 20 million people next year. All these factors are fueling interest in a market for cash-only doctors. These physicians skip taking insurance in exchange for flexibility.

In the last six weeks, Brittany Pollard has made more progress on managing her chronic pain than over the last six months. She credits her new doctor in Chicago.

“I really felt listened to — not just a problem to be fixed,” she said. “Not just a billing code.”

Pollard works for herself as a postpartum doula, helping families with newborn care. She used to buy insurance on the marketplace but was still paying hundreds of dollars out-of-pocket for urgent care visits because of her $9,200 deductible.

“Ultimately, I was paying for a plan that I never used,” Pollard said.

She dropped the coverage and signed up for what’s called direct primary care: essentially, a membership with a physician. Pollard pays $90 a month for unlimited appointments, calls, or in-office care with her doctor, Amy Schroeder.  

“I feel like I can do a much better job in this model,” Schroeder said, “whereas in the others, I felt handicapped.”

Schroeder said pressure to see more patients and insurance denials often got in the way of care. Now she gets patients discounted cash rates for labs, X-rays, and other tests.

“I love saving people money,” she said. “I love it when I look up the cost of a lab, and I'm like, ‘This only costs $2.’” 

Schroeder stresses this is not a substitute for insurance. However, many of her patients are gig workers like Pollard and are choosing this cash-only model over coverage they can’t afford.

But Schroeder said other care can be expensive for her patients. “That's a challenge to be able to hook them up with things like therapy or specialty care.”

People who choose this often understand that going without coverage is risky. Brittany Pollard worries about what would happen if she gets into a car accident or has cancer. 

“This is filling a gap,” Pollard said, “I was falling through the cracks of the system, and this has gotten me the support that I need so I can live my life.”

This cash-only model is spreading. The American Academy of Family Physicians estimates that about one-tenth of their members offer it; that’s triple the amount just a few years ago.  

“We've kind of reached a critical mass,” said Dr. Jeffrey Davenport, president of the trade group the Direct Primary Care Alliance.

He’s now seeing the idea spread beyond family physicians.

“The pediatricians are catching fire,” Davenport said. “Even specialist internal medicine doctors — hematology, rheumatology, endocrinology.”

Next year, monthly health insurance premiums are set to more than double for many who buy coverage on the marketplace as federal subsidies expire. That’s likely going to lead to more patients looking for cash-only care.