Is direct primary care worth it?

What you are really paying for

Direct primary care, or DPC, is a flat monthly fee for everyday care from a regular doctor. The fee is usually $50 to $200 a month. If you want the basics first, read what direct primary care is.

Whether it is worth it depends on how often you need care, what other choices you have and what matters to you. There is no one right answer for everyone.

The pros

The biggest plus is a clear price. You know what you owe each month, so you are less likely to put off a visit because of cost.

• Many practices offer same-day or next-day visits, and a way to reach your doctor by phone, text or video.
• Visits can be longer, because the practice does not spend as much time on insurance paperwork.
• Seeing the same doctor over time means small problems may be caught early, which can help you stay healthy.
• Some practices give you lower prices on certain labs and medicines.
• The membership can work with or without insurance.

The cons

The biggest drawback is that direct primary care is not insurance. It does not pay for the hospital, surgery, emergency care or most specialists.

• You pay every month, even in a month when you do not use it.
• Some things cost extra, such as labs, X-rays, scans and medicines, so ask what is included.
• Not every area has a practice nearby. Some places have only a few, and some have none.
• Wait times, who sees you and what is included can vary a lot from one practice to the next.
• Some practices have sign-up fees or a minimum number of months.

Who it tends to fit

• People with no insurance who want regular care at a known price may like it.
• People with a high deductible who pay full price for most visits may like it. Our high-deductible guide shows how to compare.
• People who are self-employed or between jobs and need everyday care may find it useful.
• People with long-term conditions, such as high blood pressure or diabetes, who see a doctor often may benefit.
• Anyone who wants a doctor who is easy to reach may enjoy it.

Three made-up examples

These are made-up examples and not real people. They show how the answer can change.

• Maria is self-employed and has no insurance. She gets sick a few times a year and has high blood pressure. A flat monthly fee gives her a regular doctor and a known cost. For her, it may be worth it, as long as she also plans for a big medical event.
• Tom is healthy and has a high-deductible plan. He sees a doctor about once a year. Paying a monthly fee may cost more than paying for his one visit, so for him it may not be worth it.
• Priya has two kids and a deductible she rarely reaches. Her family sees a doctor often for colds and ear infections. A family price may cost less than paying full price for each visit. For her, it may be worth it, and she should compare the total for a year.

Who it may not fit

People who rarely see a doctor may not get much from it. A flat fee may cost more than paying for a visit when you need one.

People who need frequent specialist care or have complex needs may need a plan that covers specialists and hospital care. Direct primary care alone will not do that.

People who cannot afford the monthly fee have another choice. A community health center (also called an FQHC, or federally qualified health center) charges based on income. Our guide on going without insurance shows how to find one.

Do I still need protection for big costs?

Yes, you still need protection for big costs. Direct primary care is not insurance. A hospital stay, an operation or a serious illness can cost a lot, and a DPC membership will not help with those bills. If you can get coverage for big costs, it is worth looking into. If you cannot, ask a hospital about its financial help program and keep a little set aside if you can.

In an emergency, call 911 or go to the nearest emergency room. Under federal law, an emergency room must check you and stabilize you even if you cannot pay.

What if the practice closes or changes?

Direct primary care practices are often small, and some close, move or change their fees. This does not happen to every practice, but it does happen. Before you sign, ask the practice these questions.

• How much notice do you give if you raise the price or close?
• How much notice do I need to give to cancel?
• If I pay ahead for months, do I get a refund if you close?
• How can I get a copy of my medical records?

Our checklist of questions covers all of these. You can also compare prices in our cost guide, and look for a practice with our doctor search.

How to decide

Start by adding up what you spent on doctor visits and on labs or medicines in the last year. Then get the real monthly price from two or three practices, including any sign-up fee.

Ask each practice what the monthly fee includes and what you would still pay for. Compare the full-year totals, and also think about how much you value easy access to a doctor you trust.

Finally, make sure you have a plan for large costs, such as insurance or a savings cushion.