What Direct Primary Care Is, and Whether It Fits Your Life

It is 8:02 a.m. You have been on hold with your doctor's office long enough to finish your coffee. The cough has lasted two weeks. The next open appointment, when you finally reach a person, is in late November, with someone you have never met.

You hang up and feel it in your shoulders. That small, familiar defeat. Then the guilt: maybe I am overreacting, maybe I should just wait it out.

You are not overreacting. You are not difficult for wanting a doctor who remembers you. You are asking for the part of medicine that was always supposed to be there.

That longing is why so many people are curious about direct primary care. I spend my days building systems for mission-driven businesses, and the pattern I see everywhere is the same: when the relationship gets squeezed out of a service, people feel it long before anyone measures it. Medicine is no exception.

This guide explains how direct primary care works, what the evidence actually shows and where it falls short. It is not medical or financial advice. It is a map, so you can have a better conversation with a practice, your insurer and your own doctor.

What is direct primary care?

Direct primary care, often called DPC, is a membership model where you pay your primary care practice a flat monthly, quarterly or annual fee, and in return you get broad access to primary care without per-visit insurance billing.

The American Academy of Family Physicians describes it as a fee that covers all or most primary care services, including clinical, laboratory and consultative services, plus care coordination and comprehensive care management. The AAFP also notes that monthly fees generally range from $50 to $100, and that DPC practices typically do not accept insurance or participate in government programs.

According to an AAFP explainer, that fee typically covers:

• Extended visits, in person or virtual.
• Care coordination and ongoing care management.
• Sometimes vaccinations and simple lab work.

The same explainer notes that some practices negotiate cash discounts with lab chains and imaging centers, or patients use insurance for those services. Every practice is different, so treat this as a list of things to ask about, not things to assume.

Why does it feel so different from a regular doctor's office?

It feels different mainly because each doctor cares for far fewer people. The AAFP reports an average DPC panel of 413 patients. By comparison, a 2025 study in the Journal of the American Board of Family Medicine of 21,770 family physicians found an average panel of 1,933.

Here is the number that explains your hold music. A University of Chicago-led study published in 2022 estimated that following national guidelines for preventive, chronic and acute care would take a primary care physician 26.7 hours a day for an average-sized panel.

Read that again. Twenty-six point seven hours, in a twenty-four hour day.

So if your last visit felt rushed, that was not your doctor failing you, and it was not you asking too much. The math was broken before either of you walked into the room. The system simply leaves too little time for the relationship most doctors want too.

DPC tries to fix the math by shrinking the panel. That is its whole bet.

What does the evidence actually show?

The honest answer is that the evidence is promising but thin: it comes mostly from employer case studies and observational research, not large randomized trials.

The most cited actuarial analysis is a 2020 Society of Actuaries report prepared by Milliman, which studied one employer that offered a DPC option. After adjusting for age, gender and health status, the DPC option was associated with:

• 12.6% lower overall use of health care services, statistically significant.
• 40.5% fewer emergency department visits, statistically significant.
• 19.9% fewer hospital admissions, which was not statistically significant.

And here is the part that rarely makes the brochure: the same report estimated the DPC option increased the employer's total plan costs by 1.3% once the membership fees were counted. It also noted that the single-employer design could not fully rule out healthier people choosing DPC. One employer is a case study, not a verdict.

There is a deeper reason to take the model seriously, though, and it is about relationship rather than money. A 2018 systematic review in BMJ Open found that 18 of 22 studies reported significantly lower mortality with greater continuity of care, meaning seeing the same doctor over time. All of that evidence was observational.

"Despite substantial, successive, technical advances in medicine, interpersonal factors remain important." Pereira Gray and colleagues, BMJ Open, 2018

DPC does not own continuity; plenty of traditional practices protect it fiercely. But a model built around fewer patients per doctor is at least pointed in that direction.

Do you still need health insurance with direct primary care?

Yes. Direct primary care covers primary care, not emergencies, specialists, surgery or hospital stays, so you still need insurance for the big, expensive things.

Even the AAFP notes that DPC practices often suggest patients carry a high-deductible wraparound policy to cover emergencies. Some marketplace plans can even include a DPC medical home, which federal rules allow as long as the plan meets all its other requirements.

Think of it this way: DPC is the relationship. Insurance is the safety net. Most people need both.

How do HSAs and Medicare work with direct primary care?

HSAs became much friendlier to DPC in 2026, while Medicare generally does not pay the membership fee.

Health savings accounts. Beginning January 1, 2026, the IRS says people enrolled in certain DPC arrangements can still contribute to an HSA and can use HSA funds tax-free for the periodic fees. Under IRS Notice 2026-5, the fees for a qualifying arrangement cannot exceed $150 a month for one person or $300 for more than one, and the arrangement cannot include things like procedures needing general anesthesia or prescription drugs other than vaccines. The rules have fine print, so confirm with your plan administrator or a tax professional.

Medicare. Medicare.gov states that Medicare does not cover membership fees for concierge care. Some membership doctors have also opted out of Medicare entirely. If yours has, Medicare will not pay for any service you get from that doctor, even Medicare-covered ones, except in emergencies. Ask this question first if you are on Medicare.

What should you ask before you join a practice?

Ask exactly what the fee includes, what costs extra and how the practice handles care it cannot provide. A good practice will answer in plain language and in writing.

Here is a short list to bring to a meet and greet:

1. What does the monthly fee cover, and what is billed separately?
2. How many patients does each doctor care for, and is there a cap?
3. How fast do you respond to messages, and who answers after hours?
4. Do you bill my insurance for anything, or is it fee only?
5. How do you coordinate with specialists and hospitals when I need them?
6. If I am on Medicare, have you opted out?
7. How do I cancel, and is there a waiting period to rejoin?

If you are using a practice that also offers longevity or anti-aging services, my guide on choosing a longevity clinic covers the red flags worth knowing. And whatever model you choose, an AI assistant can help you prepare questions for your visit, as long as you use it safely and with clear limits.

If you have a doctor you trust today, talk with them first. Ask what they would do in your shoes. The best choice may be staying put.

I think about the kind of care I want around my own child, who is about to arrive. Not a faster transaction. A person who knows our family's story, who notices when something has changed and who has time to say, "Tell me more."

That is who you get to be in your own care: not a chart number on hold at 8:02 a.m., but a known person in an ongoing relationship. Whether you find that through direct primary care, a traditional practice or something else, it is worth asking for out loud. Connection is part of health, just as it is part of a well-lived life.

The Future of Wellness letter is education only. It is not investment, medical or financial advice, and it is not an offer to sell or a solicitation of an offer to buy any security. No business or practitioner mentioned in this letter paid to be included. If New Earth Capital ever has a financial interest in a business named here, the letter will say so. This is education, not medical advice. Talk with your doctor or provider about your own health.