Direct Primary Care: A Clear Guide to Costs, Benefits and What to Expect

Direct primary care, or DPC, is a health-care alternative that’s gaining traction in the US with close to 3,000 practices in all 50 states and Washington, DC. This is a less expensive choice than concierge medicine that still promises a better relationship between patient and doctor…cuts waiting times for appointments…and offers longer visits during which your health needs can be better met.

Is direct primary care right for you? We asked consumer advocate and health-care consultant Charles Inlander to help you decide.

What Is Direct Primary Care?

The direct primary care model began about 10 years ago. How it works: Patients buy a membership in a primary care practice. The annual fee, typically paid on a monthly basis, covers your main health-care provider’s services for both preventive care as well as visits for illnesses and chronic-condition management. DPC practices operate completely outside the realm of medical insurance, so there are no co-pays. And you cannot use employer-provided insurance, Medicare or funds in an HSA or FSA to pay the annual fee. The idea is that you’ll receive a higher level of care in part because the doctor does not have insurance-related paperwork and doesn’t have to manage restrictions on visit lengths or be limited to reimbursement payments. “The best way to describe it is that you’re paying an extra fee for extra time,” said Inlander. “Think of DPC like a subscription for primary care.”

Direct Primary Care vs. Concierge Medicine

“Concierge care started back in the late 1980s and early 1990s as hospitals gained more power by buying out medical practices,” said Inlander. “Doctors were getting hurt on reimbursement, particularly by Medicare and Medicaid since the bulk of most practices are older people. Concierge services were created as an alternative. Collecting concierge fees meant that doctors could spend more time with each patient because they were no longer under insurance mandates to limit visits to 15 or 20 minutes. Because concierge fees are high, direct primary care emerged as a lower-cost alternative.

“Keep in mind that, for the most part, these care alternatives weren’t created for the convenience of patients, but for the benefit of the doctors who didn’t like the way the medical system worked for them economically. Hospitals have been buying up more and more medical practices. Today 70% of all doctors are employed by hospitals…20 years ago, it was only 5%. Doctors in both DPC and concierge medicine are doctors who are not affiliated with a hospital or who determined that they didn’t want to be a part of a hospital system—they are the last vestiges of independent doctors.”

Both concierge and DPC practices offer 24/7 access to their doctors with little or no waiting for an appointment and little time wasted in waiting rooms. DPC practices typically are available on weekdays and Saturdays…and available on Sundays for emergencies. But there are some differences…

Concierge care practices contract with their patients for fees that often start at $2,000 a year and, depending on the practice, can go to up $10,000 a year or more. The practice will bill your insurance for visits and other services, such as blood tests, that they deliver in office. Based on your medical insurance plan, you still could be responsible for co-pays and out-of-pocket costs.

Direct primary care membership also involves a contract, but direct primary care costs are far lower than concierge fees, often between $50 and $200 a month (which varies by location). Also, DPC practices do not bill your insurance (not having to deal with paperwork is partly why their fees are lower). The cost of your visits is covered under the monthly fee. If you need tests, the provider will order them for you, but in many cases, you’ll need to go to an independent facility to get them and have insurance to cover the cost. (Some practices have negotiated with area health facilities for discounted prices for tests and even medications for their members.)

You may be more likely to find DPC practices than concierge medicine practitioners in your area. “Because of the high cost of concierge medicine, it’s not available in every community. DPC can operate in areas where there are middle- and upper-middle-class people who can afford the lesser fees,” explained Inlander.

How Does Direct Primary Care Work?

After you choose a DPC practice you’re interested in (you can search for one by zip code on Mapper.DPCFrontier.com), you’ll schedule a consultation appointment. At this free session, you will get to know the provider and you can determine if the doctor and the practice are a good fit. You’ll be given details about all the DPC’s services and fees and a membership agreement to review.

Once you join, you may be asked to set up your annual wellness visit. From then on, whenever you need an office visit, whether to monitor health conditions or because of an illness, you’ll be able to get an appointment with little or no waiting time, often the same day or the next day. With fewer patients in the practice, there’s usually no waiting in the waiting room.

Important: “Direct primary care is not a substitute for medical insurance because it covers care from only the primary doctor—not specialists, medication, surgery or testing,” warned Inlander. “So if the primary care doctor recommends that you see a pain specialist or a cardiologist, for example, you need to have insurance or else you would pay out of pocket.”

Benefits of Direct Primary Care

Most primary health-care providers are gatekeepers, monitoring your medical conditions and looking out for your health. That said, there are the advantages to having a provider at a DPC practice…

No more rushed appointments

“Typically, insurance guidelines limit the amount of time doctors can spend with a patient to make certain economic returns.” said Inlander. “So, for example, if you go to a primary care doctor who takes insurance, he/she usually has a block of 20 or 40 minutes for you, depending on the type of visit—that reflects what the doctor is going to get paid by the insurance company.”

Better doctor-patient relationship

With more time to spend with you, your doctor will be better able to take care of you and address any health issues in depth.

Improved access through same-day visits

DPC practices stress little or no waiting time to get an appointment when you’re sick.

Less paperwork

Without insurance forms and other paperwork to fill out, there’s less bureaucracy for both you and the doctor.

Cost transparency

You know upfront what you’ll pay every month. There are no additional fees, like co-pays. With regular insurance, you don’t always know what you’ll be charged out of pocket beyond your plan’s co-pay for an office visit until the bill comes.

“DPC can be helpful for people who are on a very high-deductible health plan that requires an outlay of $10,000 or more before benefits kick in,” said Inlander. “Paying $100 a month for DPC rather than a few hundred dollars every time you need to see your doctor could save you money over the course of a year.”

Potential Drawbacks and Limitations of DPC

There are limitations with a DPC practice. Membership covers care from only the primary doctor. You’ll still need to maintain health insurance to cover all other aspects of your medical care, such as specialists, testing, medication, hospitalizations and 911 emergencies.

While some practices offer in-office blood tests, for example, it’s likely that you’ll need to go to an independent facility for these and other tests, such as imaging. And, of course, the membership fee is another health expense you’ll have to pay.

Costs and Membership Details

Membership fees for DPC vary by location but are roughly in the range of $60 to $200 a month. The membership typically covers office visits, follow-up visits to monitor chronic conditions, preventive care, and care coordination between your doctor and any specialists you see. Ask for all the details because not every DPC practice operates the same way. Some might cap the number of in-office visits per month, and there may be variation surrounding office and on-call hours.

Is Direct Primary Care Right for You?

If you live in an area without enough doctors and with long wait times to get an appointment…or if your doctor’s office often suggests going to urgent care when you’re sick because no one can see you fast enough…you might welcome the care and peace of mind of a DPC. But as Inlander stresses, don’t pick the type of practice…pick the right practice. That starts with vetting any doctor you’re considering. Here are his five top tips to find the best doctor for your needs…

Ask around in your community if anybody has used the DPC practice you’re considering

If you see specialists, ask them if they’ve had any experience with the practice and what they think of it.

Compare prices if there are several doctors in your area who have a DPC practice

A potential red flag is a practice with a substantially lower price than others in the area.

How convenient is the practice?

If you are a working person, is the practice open late for appointments after work? Is it accessible if you have mobility needs? Can you get to it easily?

Read the reviews on the practice’s website

Look past comments that say they’re friendly or offer valet service to find any substantive complaints such as “the doctor made me feel rushed” or “the doctor didn’t make me feel comfortable when explaining things.”

Check with your state licensing board to see if the doctor has had any actions taken against them. Sometimes that can be the reason why they’re not affiliated with a hospital.