What Are Direct Primary Care Clinics and Do They Take Health Insurance?

Direct primary care (DPC) clinics provide basic health care services for a direct monthly fee, allowing patients to receive care without relying on standard health insurance or paying per visit. While direct primary care clinics don’t accept health insurance or government health care programs, such as Medicare or Medicaid, they may offer a solution for individuals seeking regular medical care without the complexities of traditional health insurance.

Keep reading to learn more about direct primary care, including how it works, who it benefits most and what costs to expect.

On This Page

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  What Is Direct Primary Care?

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  What Are the Benefits of Direct Primary Care?

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  How Much Does Direct Primary Care Cost?

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  What Are Direct Primary Clinics?

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  Do Direct Primary Care Clinics Accept Health Insurance?

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  FAQs

What Is Direct Primary Care?

Direct primary care (DPC) is a health care model where patients pay their primary care provider a monthly membership fee — eliminating the need for insurance or paying out of pocket. Primary care providers who may run a DPC practice can include:^[1]

• Internal medicine physicians
• Family medicine physicians
• Pediatric physicians
• Physician associates
• Advanced practice registered nurses

How Does Direct Primary Care Work?

Direct primary care typically involves making monthly payments directly to your chosen provider, rather than paying per visit or service. This makes your provider similar to a lawyer on retainer — you gain access to their services as needed by paying a regular fee. You won’t need to pay premiums, copays or coinsurance, since insurance is not part of the process.^[1]

While DPC health care providers may not cover as many services as standard health insurance, covered benefits often include:^[1]

• Consultations and office visits
• Preventive care
• Chronic conditions management
• Laboratory tests
• Acute care visits

Other services — such as prescription drugs, specialist visits, urgent care, imaging and major medical procedures — may require additional out-of-pocket costs if not included in your DPC coverage.^[1]

Who Is Direct Primary Care Best For?

What Are the Benefits of Direct Primary Care?

Since direct primary care eliminates the administrative burden tied to insurance, providers typically have more time to spend with each patient. DPC clinics also tend to serve fewer people than practices that accept insurance, meaning patients often receive more personal attention and longer appointments.^[1]

DPC offers upfront pricing, so you know how much you pay monthly and which services are included. With standard insurance, out-of-pocket costs can be unclear due to deductibles, copayments and coinsurance — or whether your provider has negotiated discounts with your insurer. The transparency of DPC can help you better plan for medical expenses.^[1]

Many DPC memberships also include benefits like same-day or next-day appointments, extended visits, unlimited office access for questions and telehealth options.^[1] Additionally, monthly DPC payments may be tax deductible as medical expenses.^[3]

What Are the Disadvantages of Direct Primary Care?

Direct primary care may still require a backup health insurance plan, since it has limitations when it comes to what it covers. Without insurance, unexpected emergencies — such as a serious injury from a car accident — could leave you responsible for emergency room bills, hospital stays or diagnostic tests.

Without insurance coverage, these medical services can result in significant out-of-pocket costs.

To ensure broader protection, a high-deductible health plan is often recommended in addition to a DPC membership. However, individuals enrolled in Medicare or Medicaid may have to sign an agreement noting that their DPC services won’t be billed to their government health care program. Also, DPC payments don’t count toward your insurance deductible.^[1]

How Much Does Direct Primary Care Cost?

Most direct primary care memberships cost around $100 per month, though fees can vary by provider.^[1] In comparison, the average benchmark silver health insurance plan in the United States is $486 per month.^[4] Lower overall health care costs and increased personalized care may make DPC an appealing alternative.

In some cases, an employer may cover the cost of a DPC membership, either in place of standard health insurance or as an optional benefit.^[5]

However, depending on your health care needs, you could face higher out-of-pocket costs for services not included in your DPC membership.

What Are Direct Primary Clinics?

Direct primary clinics are health care facilities that operate under the direct primary care model.
These clinics house DPC providers, and most services included in your membership — such as consultations, minor in-office procedures and some diagnostic testing, like pregnancy tests — are offered onsite.^[5][6]

How Do Direct Primary Care Clinics Work?

When you enroll in a direct primary care membership with a clinic, you gain unlimited access to the services outlined in the agreement.^[6] Keep in mind that offerings may vary by clinic, so it’s important to review your contract to understand what’s included and what may require out-of-pocket payments. You’ll also need to continue paying your monthly membership fee to retain access to the clinic.

Do Direct Primary Care Clinics Accept Health Insurance?

Direct primary care clinics typically do not accept insurance, whether it is private or government-provided coverage.^[5] To access care, you’ll likely need to establish a membership and continue paying your monthly fee.