Direct primary care (DPC) is a membership for primary care: you pay your doctor a flat monthly fee for unlimited access to routine and preventive care without insurance billing. It is not health insurance, and it does not cover hospital stays, surgery, or specialists.
That distinction matters, so let me say it plainly before anything else. If someone is pitching DPC as a replacement for your health plan, walk away. The model works because it does one thing well: it makes everyday primary care simple, affordable, and unhurried. It was never built to pay for an ER visit or a knee replacement.
Premier Health Solutions administers a national DPC membership, sold through independent health insurance agents, so I’ll be candid throughout about what this model is good for and where it falls short. Here’s the full picture.
What Is Direct Primary Care?
Direct primary care is a practice and payment model where you pay a primary care provider directly through a recurring fee, instead of having every visit run through insurance. The American Academy of Family Physicians describes it as a model that charges a periodic fee covering most primary care services and bypasses third-party billing entirely (AAFP).
In practice, the membership usually covers office visits, preventive care, basic labs, care coordination, and direct messaging or calls with your doctor. Because the practice isn’t billing a carrier for each service, the doctor carries a smaller patient panel and can spend real time with you. Longer appointments, same-day or next-day scheduling, and a phone number that reaches your actual care team are the everyday payoff.
What you give up is the insurance safety net. DPC covers the care that happens in the primary care office. It does not pay for anything beyond that.
Is Direct Primary Care Insurance?
No. Direct primary care is not insurance, and most states have written that into law. More than half of states have passed statutes that explicitly classify DPC as a non-insurance arrangement, exempting it from insurance regulation (healthinsurance.org).
A few practical consequences follow from that:
- DPC is not minimum essential coverage. It doesn’t satisfy any coverage requirement on its own. If you want to understand what does count, see our explainer on minimum essential coverage.
- There’s no network for the “rest of your care.” A specialist, hospital, or imaging center won’t bill your DPC membership, because these services are not part of your Primary Care membership coverage.
- There’s no claims process. You pay the membership fee and in return you get care from a family practice or internal medicine primary care doctor.
The cleanest way to think about it: you have insurance for the expensive, unpredictable events. Direct Primary Care is there for the routine healthcare services you actually use during a normal year. They solve different problems, which is exactly why many people carry both.
How Does Direct Primary Care Work?
You sign up with a participating practice or a national membership, pay your fee on a monthly or annual basis, and start using primary care without copays at the point of service. A typical membership includes:
- Unlimited visits for routine and preventive care, with no per-visit charge
- Longer appointment times and easier scheduling
- Direct access to your provider by phone, text, or telehealth
- Basic in-office labs and procedures, often at little or no extra cost
- Help managing chronic conditions like diabetes, asthma, or high blood pressure
Some memberships are tied to a single local clinic. Others, like our NextStep Health program, run across 47 states and add 24/7 telemedicine, a bilingual patient advocacy line that books your care for you, and discounted prescriptions across tens of thousands of pharmacies. The structure varies, but the core promise is the same: pay one predictable fee, get unhurried primary care.
How Much Does a Direct Primary Care Membership Cost?
DPC memberships across the country cost anywhere between $99 to $350 a month, and, while some programs, like the NextStep Health plan, offer a flat rate, some locations correlate price of the membership with the age of the member, with older members paying more per month. Independent practices in metro areas tend to charge more than rural ones, and family pricing brings the per-person cost down.
Regardless of where you get a Direct Primary Care membership, read the membership terms closely. A genuine DPC fee should be the whole price for the listed primary care services. If a practice still bills your insurance on top of the membership, that’s concierge medicine, not direct primary care, and it’s a different product (more on that below).
Can You Use an HSA to Pay for Direct Primary Care?
As of January 1, 2026, yes, within limits. This is the part of the DPC story that changed most recently, and a lot of older articles online haven’t caught up.
Before 2026, enrolling in a DPC membership could actually disqualify you from contributing to a health savings account, because the IRS treated the membership as a second form of coverage that conflicted with HSA rules. The One Big Beautiful Bill Act changed that. Under IRS guidance issued in late 2025, an otherwise eligible person can now pair a qualifying DPC arrangement with an HSA and use those pre-tax dollars to pay the membership fee (IRS).
The fee limits are capped at $150 a month for an individual arrangement and $300 a month for one covering more than one person. The arrangement also has to be primary care only to qualify (which the programs we’re talking about are). If you have a high-deductible health plan and an HSA, this makes pairing the two meaningfully cheaper after-tax. If you have a health FSA instead, DPC membership fees may also qualify as an eligible expense, so it’s worth checking with your plan administrator.
As always with tax questions, confirm your own situation with a tax professional. This isn’t tax advice.
What DPC Looks Like in Practice
Direct Primary Care is a strong fit for hourly and physically demanding jobs, where an employer can buy memberships so workers manage chronic conditions like high blood pressure or diabetes without missing shifts.
Here’s where it clicks for a lot of people: A framing contractor, for example, bought DPC memberships for his crew. One of his most dependable guys, a man in his fifties, had blood pressure running high and his A1c creeping into diabetic range. He’d kept putting off a doctor because a clinic visit meant half a day off the job and a bill he didn’t want.
With the membership, he books a same-day telehealth call on his lunch break, gets his medication managed, and picks up refills at a pharmacy near the site. His numbers came down, and he barely lost an hour of work doing it. The owner keeps a skilled, reliable worker healthy and on the job instead of losing him to an afternoon in a waiting room, or to an ER visit down the road. For a small employer, that’s the everyday math that makes DPC pay off.
Direct Primary Care vs. Concierge Medicine
These two get mixed up constantly, and the difference comes down to insurance. Concierge practices charge a membership fee and still bill your insurance for visits. DPC practices charge the fee instead of billing insurance. That single distinction drives most of the others.
Neither is “better.” They serve different budgets and different expectations. DPC is the leaner, more transparent option for routine care.
| Direct Primary Care | Concierge Medicine | |
| Monthly cost | Typically $99-$350 | Often several hundred dollars or more |
| Bills your insurance? | No | Yes, on top of the fee |
| Who it tends to fit | People who want affordable, transparent everyday care | People who want premium access and don’t mind paying for it |
| The trade-off | No coverage beyond primary care | Higher cost, still tied to the insurance system |
Do You Still Need Insurance With Direct Primary Care?
In almost every case, yes. DPC handles the doctor’s office. It does nothing for a hospital admission, a surgery, a cancer diagnosis, or a specialist you need to see. Those are the bills that wreck a household budget, and that’s precisely the risk insurance exists to absorb.
The sensible play for many people is to pair DPC with coverage for the big stuff. A few common combinations:
- DPC plus an ACA or high-deductible plan. You get unlimited primary care without copays, and your insurance is there for emergencies and major care. With the 2026 HSA change, a high-deductible plan plus DPC is a particularly clean pairing. If you’re weighing your options after recent marketplace changes, our 2026 coverage playbook walks through them.
- DPC plus short-term medical. For people between jobs or waiting on other coverage, short-term medical insurance can cover unexpected major events while DPC handles the routine.
- DPC plus supplemental benefits. Fixed indemnity, accident, or critical illness plans can help with out-of-pocket costs your major-medical plan leaves behind. Not sure if you need them? Start with Do I Need Supplemental Insurance?.
What you should not do is drop your health insurance because you have a DPC membership. That leaves you exposed on the exact costs you can’t afford to self-pay.
Is Direct Primary Care Worth It?
The model is clearly catching on. The share of family physicians offering DPC roughly tripled from about 3% to 9% between 2022 and 2024 (AAFP), and a growing share of memberships are now employer-sponsored. Popularity isn’t the same as fit, though.
It depends on how you use the doctor. If you value time with your provider, want predictable pricing, manage a chronic condition, or just want care without the friction of copays and billing, DPC tends to pay for itself in convenience and access. People who rarely see a primary care doctor get less out of it.
The honest test is simple. Add up the monthly fee over a year, then ask whether unlimited access, longer visits, and a direct line to your care team is worth that to you. For a lot of households the answer is yes, especially now that the membership can be paid with pre-tax HSA dollars. Just keep real insurance underneath it.
How to Get a Direct Primary Care Plan
If you’re looking to get a DPC plan for yourself or your employees, the licensed advisors at Champion Benefit Advisors can walk you through your options and get you enrolled.
They’re carrier-agnostic and salaried rather than commission-driven, so the focus stays on the plan that actually fits, whether that’s a stand-alone membership or DPC paired with a health plan.
Get a quote or talk through coverage for your team at benefitchamps.com.
Gareth Patterson is Director of Marketing & Operational Efficiency at Premier Health Solutions, a third-party administrator based in Frisco, TX that has administered supplemental and limited-benefit programs since 2012.
