Healthcare in the U.S. can be confusing. Between premiums, deductibles, copays, and network restrictions, many people feel like they’re paying more and getting less. And they are right! That’s why a growing number of individuals, families, and employers are turning to Direct Primary Care (DPC) as a simpler, more affordable option.
But how does DPC actually compare to traditional health insurance? Let’s break it down.
What Is Direct Primary Care (DPC)?
Direct Primary Care is a membership-based model where patients pay their doctor a flat monthly fee for unrestricted access to primary care services. This often includes same-day or next-day appointments, extended visits, virtual consults, lab testing, and ongoing wellness support.
In DPC, there’s no third-party insurance company in the middle. That means more time with your doctor, fewer delays, and care that focuses on the patient – not on billing codes.
What Is Health Insurance?
Health insurance is designed to protect against catastrophic medical costs—such as surgery, hospital stays, or serious illness. Patients pay monthly premiums to an insurance company, and in return, part of their care is covered. But coverage usually comes with:
- Copays at every visit
- Deductibles that must be met before benefits kick in
- Prior authorizations or restrictions on which treatments are allowed
- Very limited time with your doctor
Health insurance is very useful for big medical events, but it’s often not the most efficient tool for day-to-day primary care.
DPC vs. Health Insurance: Side-by-Side
| Direct Primary Care (DPC) | Health Insurance |
| Predictable costs with one monthly fee | Unpredictable costs that include monthly premium plus copays plus deductibles |
| Treats illness and focuses on prevention | Treats illness |
| Personalized care depending on patient needs | Care is dictated by insurance rules and regulations |
| Same day or next day appointments | Long wait times to get appointments |
| DPC doctor can use any therapy to treat the patient | Insurance company only approves certain therapies |
| More time with a patient and no dictated requirements make doctor-patient relationship more direct and efficient | The majority of time with patient is spent with required checkups, leaving little time to address the actual health issue |
| Doctor has time to create personal relationship with patient | Not enough time to get to know the patient more closely |
| Reduced bureaucracy, doctors get paid immediately | High administrative burden, doctors get paid several months late |
| No coverage for major medical events | Coverage for major medical events |
| Promotes healthy patients | Promotes sick patients |
So Which One Is Better?
Think of DPC and insurance as complementary, not competitors.
- DPC is best for everyday health needs: checkups, illness visits, preventive care, chronic condition management, and personalized health planning.
- Insurance is best for the unexpected: accidents, hospitalizations, surgeries, or major illness.
Many people find that the most cost-effective and health-supportive option is to pair a DPC membership with a high-deductible or catastrophic insurance plan. That way, they enjoy comprehensive primary care without breaking the bank—and still have protection against big medical expenses.
FAQ: Direct Primary Care vs. Insurance
If I have insurance, do I still need DPC?
Yes – insurance won’t get you longer appointments, same-day access, or personalized preventive care. DPC fills that gap.
Can I use my insurance with DPC?
DPC practices typically don’t bill insurance. Your membership covers primary care directly. But you can still use insurance for specialist visits, hospital care, labs, or prescriptions outside the DPC office.
Is DPC expensive?
Most memberships cost less than a monthly cell phone bill. Because DPC reduces ER visits, unnecessary referrals, and duplicate testing, patients often save money overall.
What about labs and medications?
Many DPC practices offer deeply discounted lab tests and prescriptions – sometimes up to 90% lower than retail prices.
A Note for Oregon Residents
In May 2025, Governor Tina Kotek signed House Bill 2540, which ensures that health insurance companies in Oregon must now credit member deductibles with payments made for out-of-network primary care – including Direct Primary Care memberships.
This is a big step toward making DPC more accessible and affordable for individuals and employers alike.