Detailed DPC vs insurance calculator: use your own numbers

How the math works

The tool does simple multiplication and addition. It does not guess your prices. The only built-in number is the starting monthly fee of $75, and you can change it. Every other dollar box starts blank so the answer fits your own situation.

The direct primary care path

1. Multiply the monthly fee by 12 months.
2. Add any one-time sign-up fee.
3. Add the cost of lab tests, which is the number of tests times the price at the practice. Visits count as $0 because most practices include them in the fee.

The health plan path

1. Multiply the monthly premium by 12 months.
2. Add copays, which is the number of visits times your copay.
3. Add the part of your care that falls under the deductible, up to the size of the deductible. This covers the lab tests, and the visits too if you did not enter a copay. After the deductible is met, the tool assumes the plan pays the rest.

If you enter a premium, the tool also shows a third total, which is the direct primary care path plus your premiums. If you enter the premium of a cheaper plan, the third total uses that premium instead. This shows what it can cost to keep a plan for big events while also paying a DPC fee.

What the tool leaves out

Real plans can charge coinsurance, which is a percentage of the bill you pay after the deductible. They also have yearly out-of-pocket limits, networks of doctors, and separate rules for medicines. The tool does not model these. It also leaves out hospital stays and emergencies. Direct primary care does not pay for those, and the amounts vary too much to guess.

Where the numbers come from

• The $50 to $200 monthly range is the figure the Foundation uses for direct primary care. The American Academy of Family Physicians (AAFP) reported in October 2025 a narrower range for single adults, which is $50 to $100. It listed $20 to $49 for children and $100 or more for families. Your price depends on the practice and on who is joining.
• Direct primary care is not health insurance. Our guide on whether direct primary care counts as insurance explains this. Our guide on direct primary care cost lists what is usually not included.
• The average Marketplace deductible of $3,786 in 2026 comes from a KFF analysis published May 19, 2026. It is shown only as a reference and is never used in your math.
• The IRS says that starting January 1, 2026, people who can put money in a health savings account may use it to pay some direct primary care fees. Federal law sets a monthly limit on the fee, which is $150 for one person and $300 for a family in 2026, according to the AAFP. Read the IRS announcement and our HSA guide.

Do you still need insurance with direct primary care?

A direct primary care fee pays for everyday visits with your doctor. It does not pay for hospital stays, emergency room care, surgery, scans done outside the practice or most specialists. A big event can cost many thousands of dollars.

Because of that, many people pair a direct primary care practice with health coverage for big events. If you are not sure what coverage fits your income, try our Medicaid eligibility calculator or visit HealthCare.gov.

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.