Direct Primary Care (DPC) is one of the most talked-about models in healthcare right now—and one of the least understood by the agents who should be selling it. If you’ve heard of DPC but aren’t sure how to position it, who it’s for, or how it fits alongside supplemental products, you’re not alone. Most agents are in the same boat.
That’s about to change. DPC is growing fast, it’s increasingly available through providers and TPAs like PHS, and agents who learn to position it now will have a meaningful head start as the model goes mainstream.
What Direct Primary Care Actually Is
Direct Primary Care is a membership-based healthcare model. Instead of billing insurance for each visit, a DPC program charges patients a flat monthly fee—typically $100–$150 per month for an adult—that provides all primary care services for a set visit fee. Doctor visits, basic labs, preventive screenings, chronic disease management, and often urgent care are often included in the membership. No copays., deductibles, claim forms, or network restrictions.
The model works because DPC practices limit their patient panels to 400–600 patients per physician, compared to 2,000–2,500 in a traditional practice. Smaller panels mean longer appointments (30–60 minutes vs. the typical 7–15 minutes), same-day or next-day access, and direct communication with the physician by phone, text, or email.
DPC is not insurance. It’s a primary care delivery model that operates alongside insurance. Members still need coverage for hospitalization, surgery, specialist referrals, and catastrophic events. DPC replaces the primary care component of healthcare—the part most people use most often—with a simpler, more accessible, and often less expensive model.
Why DPC Matters for Your Clients
The value proposition for DPC comes down to three things: access, cost, and simplicity.
Access
In traditional healthcare, getting a primary care appointment can take weeks. In DPC, same-day or next-day appointments are the norm. Many practices offer virtual visits as well. For working adults who can’t afford to wait two weeks for a doctor’s appointment—or who avoid the doctor entirely because of the hassle—DPC removes the barrier.
Cost
The flat monthly fee plus visit fee replaces copays, coinsurance on primary care visits, and out-of-pocket costs for basic labs and screenings. For someone who sees their doctor 4–6 times per year and gets routine bloodwork, the DPC membership can be less expensive than the copays and cost-sharing they’d pay through traditional insurance—while getting dramatically better access and longer appointments.
Simplicity
No insurance claim is filed for primary care. No pre-authorization or network confusion. Even better, no surprise bills for a routine visit. The member pays their monthly fee and uses the service. It’s the healthcare experience most people wish they had.
Who DPC Is For
DPC isn’t for everyone, and positioning it correctly means knowing who benefits most:
| Audience | Positioning |
|---|---|
| People with high-deductible health plans | DPC effectively moves primary care outside the deductible. Instead of paying $200+ for a doctor visit that goes toward a deductible they may never meet, they pay a flat monthly fee for unlimited primary care access with a set visit fee. |
| Self-employed and gig workers | For people buying their own insurance, DPC paired with a catastrophic or short-term medical plan can be significantly less expensive than a comprehensive ACA plan while providing better primary care access. |
| Small employers | Employers increasingly pair DPC memberships with high-deductible plans or ICHRA allowances. Employees get exceptional primary care access, and the employer reduces overall benefits costs. |
| Health-conscious individuals | People who value a proactive relationship with their doctor—regular check-ups, preventive screenings, chronic disease management—get more from DPC than from a 7-minute appointment in a traditional practice. |
| Families with young children | Frequent well-child visits, sick visits, and the general unpredictability of children’s healthcare needs make DPC’s unlimited-visit model particularly valuable for families. |
How DPC Fits With Supplemental Products
Here’s where DPC gets really interesting for agents: it’s not a standalone product. It’s a primary care solution that creates demand for supplemental products to cover everything else.
A client using DPC for primary care still needs:
- Catastrophic or short-term medical coverage for hospitalization and major medical events
- Fixed indemnity for specialist visits, diagnostic imaging, and procedures outside the DPC scope
- Hospital indemnity for inpatient stays that DPC doesn’t cover
- Critical illness for the financial protection a DPC membership can’t provide during a cancer diagnosis or heart attack
- Accident insurance for injury-related events that go beyond primary care
DPC doesn’t replace these products—it works alongside them. And the conversation about DPC naturally opens the door to the supplemental products conversation. When a client understands that DPC covers their primary care, the next question is “what covers everything else?” That’s your cross-sell opportunity.
The ICHRA Connection
DPC and ICHRA are increasingly paired together. The IRS confirmed that DPC memberships can be reimbursed through ICHRA arrangements, which means employees at ICHRA-offering employers can use their allowance to pay for DPC memberships.
For agents working with employer groups that have adopted or are considering ICHRA, DPC becomes part of the benefits conversation. The employer funds the ICHRA. The employee uses it for DPC plus individual health coverage. And the supplemental products that fill the remaining gaps—fixed indemnity, accident, critical illness—are where PHS and independent agents create additional value.
Positioning DPC in the Sales Conversation
The key to selling DPC is reframing how the client thinks about healthcare spending. Most people think of healthcare as: “I pay my premium, then I pay my deductible, then I pay my coinsurance, and eventually insurance kicks in.” DPC flips that script.
The conversation framework:
- Start with the pain — “How long does it take you to get a doctor’s appointment? How much do you pay per visit? How long is the appointment?” Most people are frustrated with the answers.
- Introduce the alternative — “What if you could see your doctor the same day, talk for 30 minutes instead of 7, and pay an inexpensive visit fee? That’s what DPC does.”
- Address the gap — “DPC covers your primary care beautifully. But you still need protection for the bigger stuff—hospitalization, surgery, major illness. That’s where supplemental coverage comes in.”
- Build the package — Present DPC as the primary care foundation, paired with the supplemental products that provide complete financial protection.
PHS and Direct Primary Care
Premier Health Solutions administers DPC products on behalf of our partners, handling the enrollment platform, billing, and member account management that keeps DPC memberships active and members connected to their practices. When DPC is part of a broader supplemental benefits package administered, independent agents and members benefit from consolidated billing, unified account management, and reporting through the Nexus analytics platform.
DPC is still early in its growth curve, which means agents who learn to position it now—and who can pair it effectively with supplemental products—are building a skill set that will become increasingly valuable as the model scales.
Premier Health Solutions administers DPC products alongside our full supplemental portfolio, giving agents a single administrative partner for the entire benefits package. If DPC is not part of your product knowledge yet, now is the time. Learn about DPC products available through PHS.
