As these new membership-based models start to gain traction all over America, more and more patients are starting to become interested in direct primary care cost and whether it is worth the investment?
The simple answer here is this: direct primary care cost is offset by the priceless benefits it provides and can even serve as a valuable investment in the long run.
To help you determine whether direct primary care is the right fit for you, here are important answers to some frequently asked questions patients like you may have:
Unlike the traditional, insurance-based health care model where patients are charged for every service they avail of, direct primary care cost is based on a membership fee, which can be paid on a monthly, quarterly, or annual basis.
This membership fee covers a clear set of primary care services, including unlimited clinic visits, virtual consultations, direct access to your physician's personal line, and so much more. Think about your Netflix or Apple Music subscription – the concept of direct primary care is very similar to that.
A direct primary care membership cost ranges typically from $70-$150 a month for an individual adult, though prices can vary based on age, location, and services offered, with some basic plans potentially lower and more comprehensive or family plans ranging higher, occasionally up to $300 or more for premium or hybrid models. For as much as a couple of dinners out, patients no longer have to worry about unexpected or hidden charges every time they visit their doctor for services covered by the membership.
Like direct primary care, membership-based models have been a real game-changer for the healthcare industry in terms of restoring the quality of patient care it was known for before third parties, such as insurance companies and corporate hospitals, took over.
Time to set the record straight: No, your direct primary care membership does not replace your health insurance. direct primary care membership may seem like an added expense on top of your insurance plan, but the reality is the opposite.
There are many crucial points to cover when it comes to the question, "Does direct primary care count as insurance";
The most important one being: having a direct primary care membership lets you reduce your insurance plan to a cheaper one, which only covers catastrophic expenses and in-patient services.
This is possible because direct primary care cost already covers everything about primary/routine care. Clinic visits are unlimited and no longer need copay fees. Even better, patients gain access to exclusive discounted out-patient services and medication, as well as many other valuable benefits.
Direct primary care is a refreshing alternative to the frustratingly complicated insurance-based health care model we have come to loathe. For one, direct primary care membership covers a significant factor that is vital to improved health outcomes and overall patient satisfaction, and that is enough time with your doctor.
Forget wasting time queuing – you are not just another number waiting to be called with direct primary care. What doctors and patients appreciate about direct primary care is that they can sit down and hash out everything about their health and well-being. Rushed, robotic appointments are unheard of in direct primary care.
There is a highly individualized, sincere form of patient care that comes with your direct primary care membership. This is because patients have direct, 24/7 access to their primary care physician's personal line, giving them a chance to build a more tight-knit doctor-patient relationship.
In contrast to the traditional, insurance-based healthcare model, direct primary care can build a level of trust between doctor and patient. It is not uncommon for direct primary care physicians to check up on you regularly and vice versa. You are most welcome to seek medical advice from your physician via text message, video call, and the like.
In a nutshell, direct primary care is designed to improve the whole primary care experience for patients. This is why direct primary care cost includes benefits such as flexible payment terms, individual and family plans, virtual care options, and get this: out-patient services and medication at discounted rates.
Thanks to direct primary care, out-patient services, such as CBC tests and some vaccines, are offered at more affordable costs. A Complete Blood Count (CBC) test will cost you $50-$60 in a corporate hospital, whereas a DPC clinic can often offer the same test for as little as $3-$10, and sometimes even less, representing significant savings.
Moreover, direct primary care cost is incredibly worth it for people who have chronic conditions as DPC memberships dispense medication at wholesale cost. Antihistamine medicine like Cetirizine can cost you up to $14.43 for a 10-mg dosage in most primary care clinics, while DPC clinics can dispense it for only $1.08.
The savings you incur from discounted maintenance medication alone is enough to cover your monthly membership fee already!
As direct primary care practices continue to spring up all over the country in recent years, resources like DPC Nation and the American Academy of Family Physicians (AAFP) highlight common services, though there isn't a single national body that has "standardized" a set of essential services every DPC membership must universally include.
While memberships can significantly differ from one another (some memberships are DPC-Concierge Medicine hybrids, meaning they offer premium services at slightly higher costs), direct primary care cost should generally cover the following basic services:
The tax treatment of Direct Primary Care (DPC) membership fees can be complex and is an evolving area. Generally, as of early 2025, DPC membership fees themselves are not automatically considered a qualified medical expense under section 213(d) of the Internal Revenue Code that can be itemized on your tax return or paid for directly with Health Savings Account (HSA) or Flexible Spending Account (FSA) funds.
However, there have been proposed legislative changes to make DPC fees HSA-eligible. Some DPC practices may provide itemized statements for actual medical services rendered during the membership period, which might qualify for HSA/FSA use. It is crucial for patients to consult with a tax advisor or their HSA/FSA administrator for the most current guidance specific to their situation, as IRS rules can change and interpretations vary.
Any direct primary care cost is kept between doctor and patient alone. On the other hand, some Concierge Medicine practices are still able to bill your affiliated insurance company for any covered services incurred.
Given that some practices are DPC-Concierge Medicine hybrids make sure to study a membership's terms and conditions when settling direct primary care costs.
Another great thing about direct primary care is that it does not work with Medicare. True to its name, any direct primary care cost is settled between doctor and patient alone, without intermediaries' interference like insurance companies. DPC physicians typically opt out of Medicare, meaning they do not bill Medicare for their services. Medicare beneficiaries can join a DPC practice by paying the membership fee directly but must usually sign a private contract acknowledging this arrangement. They retain their Medicare benefits for services received outside the DPC practice (e.g., specialists, hospital care, or external labs/imaging ordered by the DPC doctor).
This makes health care transactions smoother, more convenient, and, yes, a whole lot cheaper. You will be surprised how much cheaper out-patient services can be without a parade of administrative staff on the clinic payroll.
In the direct primary care model, the doctors work directly for their patients. Doctors are no longer restricted by the punitive workflows mandates of insurance companies and healthcare corporate companies.
The only recurring direct primary care cost is your monthly membership fee. The application of sales tax to DPC membership fees depends on state and local laws and is not universal. Like CBC tests, vaccines, or medicine costs beyond what's included in the membership, other costs are only charged as they are incurred. For DPC-Concierge Medicine hybrids, your physician can bill your insurance company for any covered services incurred.
In many respects, direct primary care membership cost is considered a worthwhile long-term investment as it encourages patients to prioritize primary/routine care. Studies show that consistent quality routine care keeps any debilitating illnesses at bay.
And managing existing conditions before leading to ER trips, hospital confinement, and major surgeries, which cost twice as much. So, YES, direct primary care is worth every dollar as an investment towards your health.
Do you think you would benefit from a DPC doctor? We have the most extensive collection of DPC doctors in the US. Find your nearest DPC doctor in your area today at – findmydirectdoctor.com
Previous Post
