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Direct Primary Care (DPC) is not insurance and is not a substitute for insurance. However, there are certain types of health insurance plans that works well for many people if they have a DPC membership.

Insurance and DPC

Health Insurance and Direct Primary Care aka DPC: 


  • Because DPC members have access to their direct primary care doctor (DPC doctor) with no copays and no billing for services, it makes sense for some people to have health insurance with a higher deductible. This way the patient saves money by paying lower monthly insurance premiums.

  • It is common for patients to couple their High Deductible Health Plan with a DPC membership in order to avoid getting billed in the fee-for-service model in a system where there is no or hardly any transparency. Paying a flat monthly fee for all primary care services in the DPC membership model, can save patients a lot of money in out of pocket costs in the fee-for-service model.

  • Patients still need health insurance for expensive medical events, specialists and for services that can not be performed by their DPC doctors.

  • Patients still need health insurance for expensive drug prescriptions. Although many DPC doctors can dispense generic drugs at very low costs (this varies by state), many brand name and specialty drugs are expensive and patients are better served using their health insurance to help cover some of those costs.

  • In many states insurance carriers/companies do not allow DPC doctors to make referrals to specialist. Talk to your local DPC doctor about which plans in your area work best with their practice. This challenge is common with HMO plans.

  • Generally speaking, most PPO plans makes it easy for patients to see specialists. Check with your health insurance plan if you need prior authorization.

  • For employers who are looking for the optimal strategy to tie DPC together with their employer sponsored health insurance options, it is best to work with consultants that are experts in this. Here is a link to a site that will be helpful.

  • There are certain tax implications if you use DPC and have a Health Savings Account (HSA) that you or your employer contribute to. Please consult a tax adviser, and if you are an employer, please consult a benefits consultant that is very familiar with DPC.

  • DPC works well with Health Sharing Community programs, which is not insurance, but communities that shares each other's healthcare expenses. Speak to a professional to make sure this type of membership sharing plan will work for you and your family. Also make sure you pick the best type of health sharing community, they are not all the same.

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