Direct Primary Care vs. Traditional: Which is Right for You?

You may have seen ads for direct primary care (DPC) and wondered if it’s any different than the primary care experience you’ve known for years.

In the simplest terms, direct primary care uses a flat monthly membership fee paid directly to the practice, rather than the per-visit insurance billing you may be familiar with. What you get for this fee, and what stops being covered, is worth exploring.

Keep reading to learn more about how each model actually works, what you get for the membership fee, what a DPC membership does not replace, who tends to benefit most, and questions to ask before you switch.

How Traditional Primary Care Works

Traditionally, if you have a primary care provider, each visit gets billed to your insurance. Your plan pays most of it, you pay a copay or coinsurance and the practice bills for whatever a visit is coded as.

This is the model behind nearly all primary care in the United States, and for most people, it works just fine. In some cases, especially if there aren’t many PCPs in your area, it may be hard to get an appointment on short notice (causing you to use urgent care with different costs), or there may be a waitlist.

How Direct Primary Care Works

Direct primary care, usually shortened to DPC, charges a flat monthly or annual membership fee paid directly to the practice. The American College of Physicians describes it as a billing and payment arrangement made directly between a patient and a clinician for primary care services, with traditional insurance typically not involved.

When it comes to the price, the most recent published number is a survey of DPC practices: 88% reported annual adult membership between $500 and $1,499, which works out to roughly $42 to $125 a month. That survey was taken in 2015, so it’s simply an estimate; we recommend asking any individual practice for its own number.

In exchange for the fee, most or all primary care visits are included with no separate per-visit charge, and many practices include direct phone, text or video access to your doctor.

Because the practice is not billing insurance for each visit, it also does not organize its day around insurance coding. That’s one reason DPC practices can usually offer same-day or next-day appointments and visits that run 30 minutes or longer instead of the 10 to 15 minutes of a traditional visit.

DPC practices also tend to have far fewer patients per doctor than traditional practices, which is the other half of why appointments and access work differently.

What a DPC Membership Fee Does Not Cover

It’s important to understand that direct primary care is not insurance. The membership covers primary care visits with your DPC doctor. It doesn't cover specialist visits, emergency room care, hospitalization, imaging, surgery or prescription drugs, all of which would still go through your insurance, if needed.

That means most people on a DPC plan still need separate health insurance for everything outside of primary care. The American College of Physicians explains that patients with a DPC arrangement typically supplement it with a high-deductible health plan or a health savings account to cover medical needs outside of primary care.

Labs and some in-office procedures may or may not be included, and this varies widely by practice. Always ask specifically what is and is not covered by a membership you’re considering.

The Cost of DPC vs. Traditional Primary Care

Whether DPC saves you money depends on how you use primary care and what insurance you pair it with. (Learn more about self-pay primary care costs here.)

If you have a chronic condition and see your primary care doctor often, the flat fee of DPC can offer real savings compared to many copays. Access to your doctor by phone or message for medication adjustments can also mean fewer separate billed visits.

If you rarely see a primary care doctor at all and mostly need coverage for occasional illnesses and specialist access, DPC's core benefit — unlimited primary care access — is less valuable to you.

Who Tends to Benefit Most From DPC

In general, DPC is best suited for people managing one or more chronic conditions who want frequent, unhurried access to their doctor.

Those who are self-employed or otherwise buying their own insurance may be able to pair DPC with a low-cost catastrophic plan, which might be a good option.

People who travel or work irregular hours and value being able to reach their doctor directly may also benefit from what a DPC practice can offer.

When Traditional Primary Care is a Better Option

People who are on their employer’s insurance, where a traditional plan already includes reasonable access to primary care, are often fine with their primary care arrangement.

Traditional primary care is often best for those whose insurance plan already covers primary care with a low copay, making the added flat fee of DPC a straightforward extra cost rather than a savings.

Finally, people who see a primary care doctor rarely and would be paying a monthly fee for access they are unlikely to use may want to skip DPC.

Questions Worth Asking a DPC Practice Before You Join

• What exactly is included in the membership, in writing
• What "unlimited visits" really means
• Are labs, in-office procedures and vaccines included or billed separately?
• Is there a contract length or cancellation policy?
• What happens if I need a specialist referral?

You Deserve Primary Care Designed for You

Remember, direct primary care isn’t a substitute for insurance. DPC trades per-visit insurance billing for a flat monthly fee and, usually, faster access and longer appointments. Whether it saves you money depends on how often you actually use primary care and what you pair it with. Take the time to calculate what might be best for you and your family.

If you’re considering a move, read tips for switching primary care doctors, including getting your records transferred.

We’re honored to be your health ally with same-day and next-day appointments across our network. Find a primary care provider who can help you feel whole again.