Welcome to Direct Primary Care, the fourth installment in my series investigating so-called alternatives to traditional health insurance!
I started this series right around the time the Big Bullshit Bill passed and feel it's important so we all know what to keep an eye out for when shopping around during this year's open enrollment.
I've been researching options for myself and just as I expected, I've seen a tremendous increase in advertising for these "alternatives" now that nobody can afford their traditional coverage. I say this in quotes because it's important to remember that no alternative plan is a true substitute for health insurance and should always be entered into with extreme caution and thorough preparation.
TIP: Try to create some kind of vague plan about what you'd like to do/find to help your specific situation before you start shopping around so you're less likely to get your head turned by one of many "too good to be true" offers. You don't have to stick to that plan but having some idea of what you need and the resources you have will be extremely helpful in your journey going forward.
What is Direct Primary Care (DPC) and what is Concierge Medicine? Are they the same thing?
DPC (direct primary care) is a healthcare model where patients pay a monthly membership fee to a physician or practice for access to comprehensive primary care services, bypassing traditional insurance-based billing.
This allows patients to receive a predictable monthly cost for their care, with additional fees for specific services, and often includes perks like same-day appointments, extended visits, and telehealth options.
Brief History & Growing Popularity
✪ Direct primary care (DPC) emerged in the late 1990s as a movement to restore the patient-physician relationship by bypassing insurance. Despite early regulatory challenges, the model has since gained traction, with over 1,000 practices now operating nationwide.
✪ 2010: The Affordable Care Act included a provision that allowed DPC to compete with traditional health insurance options, providing a new path for growth. The model has since expanded to more than 1,400 practices across the United States, with a significant increase in the last decade.
✪ Due to increasing popularity over the last decade, the number of DPC practices has been continually growing. According to one resource, as of 2024, there were more than 2,600 direct primary care practices, including locations in every state in the U.S.
✪ On average, direct primary care practices have about 400 patients.
Is DPC a type of health insurance?
No. Direct primary care is NOT health insurance nor should it be considered a substitute for traditional health insurance. DPC is NOT considered minimum essential coverage (MEC) under the ACA.
Further, more than half the states have enacted laws specifically exempting DPC from state insurance laws and insurance commissioner oversight.
This is definitely something to consider because without it being regulated in the same way as health insurance, consumers have little to no protection when it comes to quality of care, anti-discrimination policies, denial of coverage issues, and more.
Key Features
- Subscription-Based
- Patients pay a recurring fee for primary care services.
- Direct Relationship
- Focuses on a direct relationship between the patient and the physician, reducing the involvement of insurance companies.
- Comprehensive Care
- Offers a wide range of primary care services, including annual check-ups, chronic disease management, and preventative care.
- Flexibility and Access
- Often provides same-day and next-day appointments, extended visit times, and easy access to the provider through various communication methods.
- Reduced Administrative Burden
- Eliminates the need for patients to deal with complex insurance billing and claims.
Membership Cost & Additional Fees
(This is a general estimate of the common cost for membership in a DPC but fees will vary depending on the location and the policies of each individual practice. Make sure to get specific information from every provider/practice you're considering to make sure you don't get hit by any surprises.)
- Pricing generally varies by age, with the lowest rates for children (commonly $20 to $75 per month) and the highest rates for older adults (can sometimes pay up to $150 per month).
- In most cases, the monthly fee is in the range of $50 to $100 per member.
- Discounted rates are sometimes available for couples or families, or for paying quarterly or annually instead of monthly.
- The rate for children can also vary depending on whether an adult is also enrolling along with the child.
NOTE: Direct primary care practices often require a one-time enrollment fee in addition to the membership fee.What's concierge medicine (CM)?
It's a bit different. Without going into a whole post about concierge medicine, in a nutshell it's another membership-based model that provides premium care to patients who can afford it.
CM usually requires an annual fee to receive greater access, medical attention, and patient care from a concierge primary care doctor. They have small patient lists and therefore more time to focus on "building long term, personal relationships with their patients".
They typically deal with affluent clients who are seeking a wide range of services and want access to them 24/7. This model can be useful to those with multiple health issues or very busy lives, provided they've got the budget to pay for it.
Unlike DPC doctors, CM physicians DO charge a patient's insurance company for their visit in addition to that membership fee mentioned above. This allows CM practices to have TWO forms of revenue while the patients get the help they need to pay for any services not covered by the membership fee.
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AT A GLANCE: Direct Primary Care (DPC) vs. Concierge Medicine Is DPC the same thing as concierge medicine (CM)? No. Direct primary care is NOT the same thing as concierge medicine (AKA concierge care or boutique medicine).
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Who chooses DPC vs who chooses CM and WHY?
For questions like this, I usually search something along the lines of "when might direct primary care be chosen instead of traditional health insurance" and here's what I came up with for DPC:
"Individuals or families who prioritize access to their primary care provider, want personalized care, and value transparent costs."
Wait. That sounds like everyone! Let's get more specific.
In summary:
DPC can be for those who:
- Prioritize affordability and a direct, cash-based healthcare relationship
- Want regular and immediate primary care within specific reasonable costs
- Prefer a focus on preventive care
- Need affordable management of chronic conditions
- Don't depend on insurance, Medicare, or Medicaid
CM can be for those who:
- Value luxury and premium health services
- Are willing to pay a higher fee for extensive access and amenities
- May still want to use their health insurance for some services
Because DPC arrangements are often paired with high-deductible health plans (HDHPs), they may not be the best choice for everyone but if you already have a HDHP or are considering one, membership might make sense. (More on the relationship between DPC and HSAs/HDHPs coming up.)
As always, you need to make sure whatever you choose makes financial sense for your specific circumstances. Evaluate your health needs, budget, preferences, and probable future needs before choosing DPC, CM, or any other type of plan.
What's usually covered/not covered by DPC?
Keep in mind that this is a general description of what is/is not covered by most DPCs. Coverage will vary for each practice so contact any that you're interested in for a comprehensive list of covered services and fees for services beyond the scope of coverage. Details provided in the tabs below.
What are the major pros/cons of Direct Primary Care?
I've listed some of the commonly discussed pros and cons in the tabs below. What's a "pro" for one person can be a "con" for another so check them all out and see what you think.
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Services usually covered by DPC:
- Visits: In-person and virtual appointments, often with same/next-day availability
- Home/mobile visits are sometimes available
- Communication: direct access to the doctor via text, phone, or secure messaging
- Preventive care: annual wellness visits, routine screenings, well-child/baby visits
- Acute care: treatment for acute illnesses like the flu, strep throat, minor injuries
- Nutrition/weight management counseling
- In-office procedures: minor procedures like wound repair, sutures, biopsy/excisions, cryotherapy
- Chronic disease management (diabetes, hypertension, asthma, etc.)
- Sports physicals
- Some basic, limited laboratory, imaging, pharmacy, and/or immunization services (may require further payment in addition to the patient's membership fee).
- DPC clinics may offer wholesale pricing for these services resulting in lower out-of-pocket costs.
- Direct primary care practices sometimes have on-staff professionals who can provide services such as mental health care, acupuncture, chiropractic care, etc. but this availability varies by provider/clinic.
- Visits: In-person and virtual appointments, often with same/next-day availability
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Services usually excluded from coverage by DPC:- Colonoscopies
- Obstetrical care
- Outpatient surgery
- Vasectomies
- Imaging (MRI, CT, ultrasound, x-ray, etc.)
- Specialty medicine
- DPC memberships do not cover care provided to members in other locations, such as the hospital, outpatient surgery center, or urgent care clinic.
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Predictable costBecause DPCs use a subscription-based model, they offer a set monthly or annual fee, eliminating copays, deductibles, and surprise bills. (NOTE: Additional fees may be required for enhanced services.)
Ease of booking
Patients have an easier time getting appointments quickly (usually with same-day availability)
Access to physician
Increased access to the primary care physician via direct contact through phone, text, or email, including after hours. This feature is often appealing to those with chronic conditions.
Enhanced doctor-patient relationship
Since they serve less patients, DPCs focus on building relationships, providing personalized care, and offer visit times averaging 30-60 minutes.
Reduced administrative burden
The DPC model benefits both patients and providers by eliminating the need for insurance claims, billing, and prior authorizations, thus simplifying the healthcare experience.
Focus on prevention
DPCs emphasize preventative care (physicals, screenings, health coaching) which can lead to improved health outcomes, particularly for patients living with chronic conditions.
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Not a replacement for insurance
Patients are strongly advised to carry insurance for specialty care, urgent and emergency care, hospitalizations, and other medical needs beyond those covered by the DPC.
Difficulty in locating a provider
Availability of DPC providers may be limited in some geographical areas. DPC practices tend to be clustered in higher-income areas. This is not only a negative due to patients having trouble finding them but also exacerbates physician shortages and contributes to economic/racial disparities in health care access. Some argue that the DPC model incentivizes physicians to focus on accepting healthier patients with limited needs who they view as more likely to be able to pay the monthly fee.
Fixed monthly fee
While viewed as a positive feature by some, the need to pay a monthly membership fee for the DPC can be an additional financial burden on others.
Read the fine print
Enrollees of DPCs MUST thoroughly investigate and understand what is and is not included in their membership. The DPC does not provide comprehensive coverage and additional fees for certain services/procedures can increase overall costs, making the DPC less of a bargain than expected.
Lack of regulation
Because it is not considered health insurance, DPCs are not subject to the same regulations as traditional health insurance which can lead to concerns about both cost and quality of care. If difficulties or disputes arise, consumers generally CANNOT get help from their state's department of insurance due to the DPCs exemption from oversight. (AUTHOR'S NOTE: This is my primary red flag/concern with DPCs and why I hesitate to use one.)
DPC Combined with Insurance, HSAs, and other "Alternatives"
DPC + Traditional Health Insurance
It is strongly recommended that you still carry traditional health insurance if you're using a DPC for primary care in case you need more significant or specialty care above and beyond the services covered by the DPC membership. DPCs can be used in conjunction with ACA-compliant health plans purchased on or off of the exchange (Marketplace).
If you're looking for a major medical insurance plan to pair with a DPC, keep the following in mind:
→ Check with the DPC practice to see if there is a particular hospital/provider system that they recommend or use for referrals. It can save you a lot of hassle in the long run if you choose a health insurance plan that has that same provider system in its network.
→ Be aware that the fees spent on your DPC enrollment and membership will NOT count toward your health plan's out-of-pocket (OOP) costs and will not apply toward meeting your annual deductible. You will only hit your deductible or OOP max when using providers or services for treatment outside the scope of the DPC practice.
DPC + Other Health Insurance "Alternatives"
You may see recommendations suggesting you combine your DPC with membership in a health care sharing ministry plan (HCSM).
Keep in mind, HCSMs are also NOT health insurance and won't add the level of security provided by enrollment in a traditional health insurance plan.
HCSMs are not subject to the same regulations and laws as health insurance so they carry the same risks as the DPC in regards to lack of consumer protections.
DPC + HSA (Health Savings Account)/HDHP (High Deductible Health Plan)
For those with an HSA (health savings account), under longstanding rules, contribution to a HSA has been prohibited for those with a DPC membership, even if you also have coverage under an HSA-qualified high-deductible health plan (HDHP).
This will change in 2026 as part of the sweeping changes brought about by H.R. 1 - the OBBBA (Oligarch's Big Bullshit Bill Act)* - enacted in July 2025 and which included a $40 billion expansion to tax-preferred HSAs.
*NOTE: Clearly that is not the actual name of the massive bill that is presently throwing the insurance industry and lives of Americans into chaos but I refuse to use the actual name in my writing due to personal objections to its very existence.
Regulatory changes resulting from the OBBBA
Beginning January 1, 2026, patients will be able to pay for direct primary care (DPC) arrangements with their health savings accounts (HSAs) – a change that some physicians say may lead to increased access to care for patients and less red tape for clinicians.
Under the new law, a person with an HSA-qualified health plan will be allowed to also have a DPC membership AND still be eligible to contribute to an HSA as long as the DPC meets certain federal requirements, such as:
- The DPC must provide services consisting solely of primary care services provided by primary care practitioners
- The DPC cannot provide
- procedures that require the use of general anesthesia,
- prescription drugs (other than vaccines)
- laboratory services not typically administered in an ambulatory primary care setting
- The sole compensation must be a fixed periodic fee, without per-visit charges
- The monthly DPC fee cannot exceed the allowable amounts established by the law which are $150/month for individuals or $300/month for a family, with annual adjustments for inflation.
NOTE: Starting in 2026, DPC membership fees will be considered medical expenses, meaning that the members can pay the membership fee with pre-tax HSA funds.
Federal Changes Allow Payment for Direct Primary Care Via Health Savings Accounts
Conclusion: DPC - Scam or Bargain?
Not a scam. Possibly a bargain. It really depends on your circumstances. I suppose it's always better to have SOMETHING instead of absolutely nothing and this would at least provide the security of knowing that you can get checkups and have any chronic conditions monitored, even if you've lost your traditional health insurance coverage. Just remember, as always, to read all of the fine print to avoid surprises and do some research on the practice and/or provider before making a final decision. Keep in mind, also, that DPC is not classified as health insurance so it's not regulated as such and you, the consumer, will not have the same protections that you had under your health insurance plan if any disputes arise.
My personal take: I would consider this option if I couldn't figure out anything else. I do have chronic autoimmune conditions and have to have labs run regularly so I'd try to find one that includes at least limited or basic lab services. The fees for DPC can be monthly or annual so it would be something that I could get on a short term basis if I was expecting to return to traditional insurance in the future. Of all of the "alternatives" to insurance that I've researched, this would be the one I'd be most likely to feel comfortable with trying.
Thank you for learning with me and for taking an interest in learning more about health insurance related topics! Keep checking back and bookmark my main blog page so you can catch the rest of this series. Next up will be Catastrophic Health Plans which are being pushed HARD right now, even through the traditional insurance carriers. We'll learn all about them and you'll have all the information you need to make informed decisions for you and your family's coverage and care.
Do you have personal experience with using DPC? Positive or negative, I'd love to hear all about it! You can email me or contact me by phone, text, or socials using the links on my Contact Me! Page.
Did you miss a post in this series? Want to refer to or share a previous post? No problem! Find all my blog posts listed here for your convenience.
Sources/Links for further information:
- Insurance Shopping Checklist from the TX Department of Insurance
- Federal Changes Allow Payment for Direct Primary Care Via Health Savings Accounts
- What is direct primary care? | healthinsurance.org
- Direct Primary Care (DPC): A Consumer's Guide to This Payment Model
- The Difference Between Direct Primary Care and Concierge Medicine
- Direct Primary Care - Texas Public Policy Foundation
What's next?
To keep up-to-date on news and information regarding the ACA & the Marketplace, you can check out my blog!
Go take a look at my Resources page for helpful links from the entire website, my proposed e-book (still in development due to massive ACA changes), and social media series PLUS a glossary of key terms and gallery of infographics to save/share!
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