Everything Patients Need to Know About Direct Primary Care Programs, Providers, Costs, and More!
Direct Primary Care, or DPC, is quickly becoming one of the most popular and viable alternatives to traditional healthcare. These membership-based health plans are making routine and preventive healthcare easier and more affordable than they’ve ever been.
Meanwhile, DPC physicians are increased job satisfaction, improved patient relationships, and better patient healtreporting h outcomes across the board.
The purpose of this complete guide to Direct Primary Care is to:
- Introduce healthcare consumers to DPC
- Examine the advantages and disadvantages of the DPC healthcare model
- Explain how to pair a DPC membership with effective but low-cost emergency coverage
- Explore DPC options for small business owners
- Provide resources on how to find a DPC membership in your area
Note: The Direct Primary Care healthcare model is growing rapidly. This page will continue to be updated with the most up-to-date information about DPC, including program options, cost-saving tips, and information about any state or federal changes regarding DPC.
You can bookmark this page to use it as an ongoing resource. HSA for America also provides regular updates and education about DPC practices and plans in our monthly newsletter; Click here to subscribe.
Disclaimer / About This Guide
Our mission at HSA for America is to empower our clients, friends, and visitors with the information they need to make the best decisions about their healthcare.
The information provided here about Direct Primary Care is for general education purposes only. If you have serious concerns about your healthcare strategy, schedule a time to speak with an insurance professional. These advisory appointments are no-cost to you, and there’s never an obligation to buy.
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What is a Direct Primary Care Program (DPC)?
Direct Primary Care, or DPC, is an alternative healthcare model where patients pay a flat membership fee in exchange for unrestricted access to a primary care doctor. With membership costs as low as $80 per month, DPC is becoming a popular and viable way for Americans to maintain their health without having to worry about copays or coinsurance.
DPC is not the same as health insurance. DPC does not include coverage for large or emergency health costs, like a trip to the E.R. or a stay in the hospital due to illness. For this reason, DPC works best in tandem with another form of protection, like healthcare sharing or accident insurance.
Since its inception a few decades ago, DPC has been growing in popularity. Now, in the midst of a global health revolution, DPC memberships are poised to become a critical part of modern, budget-conscious healthcare strategies.
How does Direct Primary Care Work?
DPC is a simple membership-based health plan designed just for routine primary care health services. Here’s how it works:
- The patient chooses a Direct Primary Care physician in their area and signs up for a membership. A flat-rate monthly fee, typically between $75 and $110, is paid directly to the DPC facility.
- The patient enjoys unrestricted access to routine primary, preventive, and chronic care* services. Similar to a health club membership, these patients can access their care services as often as they need.
- The patient chooses a supplemental plan to cover the things that DPC does not, like ER care, hospitalization, and prescription drugs. Because routine care is covered by the DPC membership, the patient can choose a low-cost option like a high deductible health plan, a health sharing plan, or accident insurance. (We explore DPC-friendly options further down in this guide).
*Not all DPC facilities treat all chronic health conditions; Be sure to check with your DPC provider before signing up.
Advantages of Direct Primary Care
|1.Patients Get More Time with their Doctor||DPC physicians don’t have to worry about insurance paperwork or busywork. The membership model means that every patient gets to spend more time per-visit with the doctor. In fact, current data suggests that DPC doctor appointments are nearly twice as long as traditional primary care.|
|2. DPC Memberships Are Highly Affordable||Most DPC programs are around $100, and some are even less. Many Americans pay more than this for their monthly phone bill, and it is only a small fraction of the cost of a traditional health insurance plan.|
|3. Provider Access is Unrestricted||All DPC programs have different rules, but in general, DPC gives patients unlimited access to their primary care provider. This means that fewer health issues will fall through the cracks, and patients don’t have to skip a needed appointment because they’re worried about a copay.|
|4. DPC Pricing is Transparent and Up-Front||DPC members have a flat fee that is paid monthly. No more leaving the doctor’s office wondering how big of a bill they’re going to stick you with. Simply pay your membership fee regularly and see your physician as much as you need.|
|5. Same-Day and Next-Day Appointments are Much Easier to Get||DPC programs, like health clubs, give members access to routine services as they are needed. This makes it easier for physicians to see their patients on very short notice. A growing number of DPC facilities have a physician on-call 24/7.|
|6. DPC Physicians Are Reporting Higher Job Satisfaction Rates||With more time to spend with patients and less time worrying about data entry or the insurance companies, many DPC physicians are reporting higher job satisfaction rates than ever before. What’s more, there is mounting evidence that Direct Primary Care is the “key to reducing burnout” among primary care physicians.|
|7. DPC Facilities Can Offer Additional Programs and Benefits||In efforts to compete, DPC facilities are starting to offer valuable member benefits that go beyond primary care visits. These can include yoga sessions, nutrition classes, and wellness counseling.|
Disadvantages of Direct Primary Care
|1. DPC Memberships Do Not Cover Emergency Treatment||If you get in an accident or fall severely ill, your DPC membership will not pay for hospital or ER bills.|
|2. DPC Membership Do Not Cover Prescription Drugs||Most prescription drugs are not covered by DPC memberships. Standalone drug plans and discount programs are available for patients who need them.|
|3. Monthly DPC Membership Fees Will Not Count Towards an Insurance Deductible||Your monthly DPC membership fee is not a qualified health cost when it comes to your insurance plan’s deductible, if you have one.|
|4. You Can’t Use HSA Money to Pay for DPC Membership||Under IRS rules, DPC membership fees are not HSA-qualified. However, any DPC member can continue to contribute to an HSA (as long as they are also enrolled in a qualified HDHP plan), and they can use their HSA for any out-of-pocket medical expenses..|
How to Use DPC to Save Money and Also Stay Protected
While Direct Primary Care is much more affordable than traditional health insurance, it is not usually enough to protect someone from health costs. Remember, DPC memberships do not cover hospitalization or emergency room treatment. Many specialist appointments are also not covered.
For this reason, it’s necessary to pair a DPC membership with an additional plan. Fortunately, because DPC pays for all the routine care, patients can choose a less-comprehensive, more-affordable plan. The end result is all-around health protection for much less than just enrolling in a basic insurance plan.
DPC members have two primary options to decrease their risk:
Option One: Pair DPC with a High Deductible Health Plan (HDHP)
Option Two: Enroll in a Lower-Cost DPC Health Sharing Plan
Lower-premium, high-deductible health insurance plans can be paired with DPC to provide some level of protection against emergency costs. As of 2021, most Americans qualify for additional savings that make HDHP plans more affordable per-month than ever before. (Some can even be $0 per month!).
But HDHP plans have the added risk of a high deductible. If you get sick or injured, you could be on the hook for an out-of-pocket deductible of $5,000 or more.
Anyone who is enrolled in a Health Sharing Plan can also sign up for Direct Primary Care. But in order to truly maximize savings, DPC members should consider a DPC-specific healthshare program. Because there is no need to offer routine health services, these healthshare plans are optimized to be even more affordable.
DPC Healthshare options are available through MPB Health, Sedera, and even MediShare. These options are explored further in a later section.
For All DPC Members: Continue to Contribute to Your HSA
All Direct Primary Care patients are able to operate and contribute to an HSA. The only requirement is that they are also enrolled in a qualified high deductible insurance Plan. For healthshare members, they must also be enrolled in a qualifying Minimum Essential Coverage plan.
As of 2022, tax-free HSA funds cannot be used to pay for a DPC monthly membership fee.
Healthshare Plans that Work with DPC Memberships
Anyone who is enrolled in a Health Sharing program can also participate in a DPC membership. Because health sharing plans usually only cover emergency and unexpected healthcare costs, they are a natural fit with the Direct Primary Care Model.
As DPC becomes more popular across the country, an increasing number of health sharing organizations have begun to offer specialized DPC healthshare programs. Because no preventive or routine costs need to be shared, this type of healthshare plan can reduce monthly costs significantly.
|Our DPC Direct healthshare works with an existing DPC membership to maximize savings and increase overall protection. DPC Direct includes a few unique member features including: LifeCare Program (Virtual or face-to-face counseling for personal and work-related issues) & 24/7 telehealth access.|
|Zion is a part of the same family of healthcare companies as DPC Direct. The Zion healthshare plan is very similar to the DPC Direct plan described above.|
Sedera healthshare members can receive a discount on their membership if enrolled in a qualified Direct Primary Care Membership.
Note: Information is still incoming on Sedera + Direct Healthshare. Bookmark this page and check back in the coming months for updates.
|While MediShare does not offer a DPC-specific healthshare option, they do offer cost-sharing eligibility for up to $1,800 of DPC membership fees. This is only for MediShare members who are enrolled in the $12,000 AHP option.|
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Direct Primary Care for Small Business
The low cost and significant benefits of DPC memberships make them a natural fit for small business owners who are looking to offer an employee health benefit. Many small business owners can get a group DPC membership for as low as $30 per employee (with more standard rated being closer to $70 or $80).
Other benefits of DPC for small businesses include:
- Reduced absenteeism: Employees can communicate with their provider digitally, 24/7, to manage all health needs. Many DPC facilities also offer appointments on weekends and after 5 pm, unlike traditional primary care providers.
- Better employee health: Unrestricted access means that employees can see the doctor as often as they need. This can lead to an improvement in overall health, which has obvious and proven benefits to both productivity and job satisfaction
- Less complicated than group health insurance: A single, flat-rate monthly payment is made directly to the DPC facility … That’s all there is to it.
Direct Primary Care Near Me: 3 Resources You Can Use to Find a DPC Program in Your Area
DPC Frontier Mapper
Founded in 2018, DPC Frontier operates an advanced mapping system that shows the location of 1600+ Direct Primary Care practices across the United States. Simply enter your zip code and click ‘search’ to see what’s available near you.
The Direct Primary Care Directory
The Direct Primary Care Directory is a local and national directory that provides free, mobile friendly optimized searching for DPC physicians. In addition to a zip code search, the Directory lets you search by expertise or additional services, like chronic disease management, clinical nutrition, and more.
DPC Alliance is much more than just a provider directory. This is a multifunctional resource for anyone who is looking to learn more about Direct Primary Care. DPC Alliance also hosts a number of virtual educational events, bringing DPC doctors and healthcare experts online to have meaningful conversations about the future of the DPC model.
Everything Else You Need to Know about DPCs: Direct Primary Care FAQ
Q: Why is Direct Primary Care Better?
A: Direct Primary Care can be a better model for routine health needs because of it’s low-cost and high accessibility. The unrestricted structure of a DPC membership encourages patients to see their doctor more frequently, which can lead to significant health improvements.
Q: What is the difference between direct primary care and concierge medicine?
A: Like, DPC, Concierge Medicine is a membership-based practice in which patients get easier and faster access to their physicians. The difference is that Concierge Medicine providers also charge an insurance company for the visit.
DPC physicians do not require payment from an insurance company. Memberships are paid for entirely with a monthly member fee.
Q: What is a direct care provider?
A: A Direct Care Provider is any physician or facility that has decided to operate on the Direct Primary Care (DPC) model. DPC providers are not as common as traditional doctor offices, but they are expanding rapidly across the U.S.
Q: Is direct primary care affordable?
A: Direct Primary Care plans can be significantly less than $100 per month, making them one of the most affordable health strategies available. But because Direct Primary Care doesn’t cover E.R. or hospitalization, it does not usually work as someone’s sole form of healthcare.
Q: How can I find direct primary care near me?
A: There are a number of excellent DPC directories that are adding new physicians and facilities all the time. These include DPC Frontier Mapper, the Direct Primary Care Directory, and DPC Alliance.
Q: Does my DPC membership count towards my deductible?
A: No, Direct Primary Care membership fees do not count as an eligible health expense towards your insurance deductible.
Q: Can I use my HSA to pay for DPC?
A: Tax-deferred HSA funds cannot currently be used to pay for a Direct Primary Care membership. However, it can be used to pay any out-of-pocket expenses, whether that is for a prescription drug, or imaging you need to have done, or if you end up in the ER.
Q: Is Direct Primary Care Worth It?
A: Direct Primary Care is a low-cost way to get as much routine and preventive medical care you need, all for one flat monthly rate. DPC can be well worth it for anyone who is enrolled in a health plan that doesn’t include comprehensive primary care benefits. More specifically, DPC is a good match for anyone enrolled in a High Deductible Health Plan (HDHP) or an alternative health plan like Health Care Cost Sharing.
Q: Can I Still Contribute to an HSA if I have DPC?
A: All DPC members can contribute to an HSA, as long as they are also enrolled in an HSA-qualified health plan. This can be a high deductible health insurance plan (HDHP) or a qualified Minimum Essential Coverage Plan (MEC).
Q: How much does Direct Primary Care cost?
A: The cost of a Direct Primary Care membership can range from as low as $50 to as high as $200. Costs vary depending on location, range of services, and more.
Q: Do I still need insurance with Direct Primary Care?
A: Direct Primary Care plans are not usually enough to cover a person’s annual medical costs. DPC does not cover ER, ambulance, specialists, or hospitalization, nor does it cover critical prescription drugs. If you get sick or injured, your out-of-pocket costs could be disastrous without some form of health plan in place.
Q: Can I use DPC with Medicare?
A: Yes, Medicare enrollees can also sign up for a Direct Primary Care program. However, DPC membership costs are not reimbursable by Medicare.
Q: What are the Pros and Cons of Direct Primary Care?
- Low, flat-rate monthly cost
- No copays or coinsurance
- Unrestricted access to a primary care physician
- No-copay structure of DPC encourages more visits and healthy habits
- Digital, telehealth, and on-demand video communication is available
- Next-day and same-day appointments are easier to get
- Typical DPC visits are nearly twice as long as traditional visits
- DPC encourages better doctor/patient relationships
- DPC does not cover E.R., ambulance, hospitalization, or prescription drugs
- DPC does not cover many lab tests and specialist visits that could be ordered by your physician
- There are fewer DPC facilities available (but they are growing fast)
Looking Forward: The Future of Direct Primary Care and Healthcare Freedom
At HSA for America, we believe that the most important healthcare freedom is having the option to choose from a wide range of health care alternatives.
Meet Your Free Direct Primary Care Expert
If you need help configuring your health strategy to work with Direct Primary Care, we can help. Call 800-913-0172 to be connected with a Personal Benefits Manager (PBM). Your PBM is a no-cost health plan expert who can empower you with the tools and resources to take true advantage of Direct Primary Care.
You can also click here to schedule a free consultation.
Here are some additional articles on DPCs and healthsharing programs: How to Pair a Health Sharing Plan with your Direct Primary Care (DPC) Membership | Why a Health Sharing Plan is the Perfect Complement to Your Direct Primary Care Physician
Wiley is President of HSA for America. He believes that consumers should have choice and price transparency, so they can make the best healthcare decisions for their needs. Read more about Wiley on his Bio page.