Direct primary care cost calculator: DPC vs insurance

How we figure the answers

The main answer is about everyday care. That means your usual doctor visits and routine tests in a year, with no big hospital bill. The second answer is about what happens if something big happens, such as a hospital stay. Then you pay your premium plus the most your plan lets you pay in a year. Which options we show depends on your first answer.

If you have insurance through a job

Option A is a regular plan with a lower deductible. Option B is direct primary care plus a high-deductible plan. We use numbers from the KFF Employer Health Benefits Survey 2025. They are the average worker share of the premium, the deductible and the primary care copay. Under an HSA-qualified plan, the IRS lets the plan pay for preventive care before the deductible, but other care usually counts toward the deductible. Since 2026, you can pay a DPC fee from your HSA with tax-free money. The limit is $150 a month for one person or $300 for more than one. For Option B we also subtract the average money an employer puts into a health savings account (HSA). KFF puts that at $690 for one person and $1,296 for a family. About 14 out of 100 workers in these plans get nothing. So we also show the result if your employer puts in nothing, and we show the yellow button only if option B still wins in that case.

For one person, the bad-year limits are KFF averages for the out-of-pocket maximum. KFF publishes no average for family coverage. The law sets a family limit at exactly two times the one-person limit, so for two people or a family we use two times the one-person KFF averages. That is our estimate, and your plan's real limit may be different.

If you buy your own plan, or have no insurance

If you buy your own plan, you see three lines. Option A is a standard Silver Marketplace plan. Option B is a Bronze plan alone. Option C is the same Bronze plan plus direct primary care. The only difference between B and C is direct primary care, so the gap between them shows what DPC itself adds or saves.

We use KFF 2026 averages for a 40-year-old: $611 a month for the lowest-cost Silver plan and $456 a month for the lowest-cost Bronze plan. These are full prices before any tax credit, so most people pay less. In 2026, 87 percent of people who picked a Marketplace plan got a tax credit. The credit is worked out from the benchmark Silver plan, which averages $625 a month for a 40-year-old. For a couple we count two adults. For a family we estimate two adults and two children with the federal age curve.

The Silver plan is the 2026 standard Silver plan design from the Centers for Medicare & Medicaid Services (CMS). It has a $6,000 deductible, an $8,900 limit and a $40 copay for a sick visit. The Bronze plan is not the CMS standard Bronze plan. We chose a Bronze plan where sick visits and lab tests count toward the deductible. That kind of plan is why many people skip care. For its deductible we use the average 2026 Bronze deductible of $7,186 from Peterson-KFF. For its limit we use the most the law allows, which is $10,600 for one person and $21,200 for a family. Preventive care such as a yearly checkup is usually free. Some Bronze plans, including the standard plans on HealthCare.gov, charge a $50 copay for sick visits instead. If yours does and you have sick visits, the Bronze plan alone can cost less than shown here.

If your income is below about 2.5 times the poverty line, a Silver plan can come with a much lower deductible and limit. These are called cost-sharing reductions, and this tool does not model them. Check your real Silver price on HealthCare.gov first.

If you have no insurance right now

You see three choices, which are direct primary care alone, a Bronze plan, and a Bronze plan plus direct primary care. Direct primary care alone is a real choice for everyday care, and it is often the lowest cost. But it does not cover a hospital stay. It has no limit if something big happens, and a single hospital stay can cost tens of thousands of dollars. A health plan protects you from that. We also ask one more question, "What best describes you?" It does not change any cost. It only changes which tips we show first.

• If you recently lost coverage, we explain that losing job-based coverage usually opens a 60-day Special Enrollment Period on HealthCare.gov. That is a window outside the normal sign-up dates. We also explain that COBRA can keep your old job plan, usually at the full price plus up to 2 percent. Then we show the same comparison. A small link points to the Medicaid calculator in case your income dropped.
• If a plan costs too much right now, we point to the Medicaid calculator first, because you may qualify for Medicaid or for a big discount on a plan. With a tax credit, some people with lower incomes can get a Bronze plan for $0 a month.
• If you prefer to pay cash for your care, we show the comparison. It has a plain warning that cash covers everyday care but not a big bill. It also has the same small Medicaid link.

Visits, medicines and the DPC fee

Each visit answer is for each person covered. We assume 1 visit a year for each person if you choose rarely, 3 if you choose sometimes, and 6 if you choose often. A couple counts 2 people and a family counts 4, so the total grows with the size of your household. If you take regular medicines, we add 1 visit and 2 routine lab panels to every option. On a plan, one yearly checkup for each person is usually free, and the other visits are sick visits. Every option pays the same price for the same service. A lab panel costs $18.33 everywhere. That is the Medicare lab fee, which the law sets from the middle price private insurers pay. A sick visit that skips the deductible costs the plan's own copay, which is $27 on the job plan and $40 on the Silver plan. A sick visit that waits for the deductible costs about $116. That is the Medicare rate of $95 times 1.22, which is what private insurers pay on average compared with Medicare. Visits to a DPC doctor have no extra charge. Many DPC practices also offer common lab tests and generic medicines at low prices, so ask the practice.

The DPC fee is $75 a month for each adult and $35 a month for each child. For just me, we count one adult. For me and a spouse or partner, we count two adults. For my family, we count two adults and two children. If you are a single parent, your real costs are lower than the family numbers.

What this page leaves out

Medicine prices, coinsurance, doctor networks, tax credits and cost-sharing reductions for Silver plans are not modeled. If you know your own premium, try the detailed calculator and enter your real numbers. The numbers are 2026 prices. Marketplace sign-up for 2027 plans runs from November 1, 2026 to January 15, 2027 in most states. Pick a plan by December 15 for a January 1 start.

Is direct primary care insurance?

Direct primary care is not insurance. A DPC fee pays for everyday visits with your doctor. It does not pay for hospital stays, emergency room care, surgery or most specialists. That is why a health plan is worth having if something big happens. Our guide on whether direct primary care counts as insurance explains more.

What if I have an emergency?

If you think you are having an emergency, call 911 or go to the nearest emergency room right away. Emergencies include chest pain, trouble breathing, heavy bleeding and signs of a stroke.

Federal law requires an emergency room to examine and stabilize you whether or not you have insurance (read about the law). This tool is general education and not medical, legal or tax advice.