Is Direct Primary Care a Health Plan?
As healthcare costs continue to rise and insurance premiums become more complex, many individuals and families are searching for more practical cost-effective ways to access medical care. Direct primary care (DPC) has emerged as a promising alternative to the conventional healthcare system—one that prioritizes affordability, accessibility, and the patient-provider relationship.
A common question that arises is “Is direct primary care a health plan?” The answer is nuanced. No, direct primary care is not a health plan in the traditional insurance sense. However, it can be a valuable complement to existing health coverage, and in many cases, it serves as a more affordable, personalized option for primary urgent care, or even naturopathic services.
In this article, we’ll explore what direct primary care is, how it differs from insurance-based health plans, the benefits it offers, and why it might be the right choice for you or your family.
What Is Direct Primary Care?
Direct primary care (DPC) is a healthcare model in which patients pay a monthly, quarterly, or annual fee directly to a primary care provider in exchange for unlimited access to a wide range of services. This flat membership fee covers most, if not all, of the patient’s basic healthcare needs—without involving insurance companies.
Typical services offered through DPC include the following:
Preventive care and wellness exams
Management of chronic conditions such as diabetes or hypertension
Same-day or next-day appointments
In-office procedures and basic labs
Urgent care for minor illnesses or injuries
Telehealth consultations and ongoing communication via phone or email
Naturopathic and integrative services, in some practices
This model removes the traditional fee-for-service billing system, streamlining the healthcare process and allowing providers to focus more fully on patient care.
How DPC Differs from a Traditional Health Plan
A traditional health plan—whether purchased individually, through an employer, or via a government program—is a form of insurance that covers various medical services based on a contract with a health insurer. These plans usually include deductibles, co-pays, provider networks, pre-authorizations, and claims processing.
In contrast, direct primary care is not insurance. It does not cover hospitalization, specialist visits, surgeries, or catastrophic events. It is a service arrangement for primary care only—and as such, it does not meet the legal definition of a health insurance plan under the Affordable Care Act (ACA).
However, direct primary care can be combined with high-deductible health plans (HDHPs), health-sharing ministries, or catastrophic insurance to ensure that major healthcare needs are still covered. In this hybrid model, DPC handles everyday care, while insurance is reserved for emergencies and specialized services.
Benefits of Direct Primary Care
Though direct primary care is not a health plan in the traditional sense, it delivers numerous benefits that rival—and often surpass—what many individuals experience under insurance-based primary care. Below are some of the key advantages:
1. Predictable, Transparent Pricing
DPC membership fees are simple and easy to understand. Patients know exactly what they will pay each month, without the stress of co-pays, surprise bills, or complicated explanations of benefits.
2. Improved Access to Care
Members of DPC practices typically enjoy same-day or next-day appointments, extended office visits, and direct communication with their providers. Many clinics also offer virtual visits, allowing patients to receive care from the comfort of home.
This enhanced access reduces the need for urgent care and emergency room visits, both of which are significantly more expensive than routine office care.
3. Personalized, Relationship-Based Medicine
Traditional providers may see thousands of patients and are often pressured to limit appointment times. DPC physicians typically manage a smaller patient panel—often around 300–600 patients—allowing them to spend more time with each individual and provide highly personalized care.
This focus on the patient-provider relationship often leads to improved health outcomes and greater patient satisfaction.
4. Cost Savings on Labs, Medications, and Imaging
Because DPC practices operate independently of insurance contracts, they often negotiate direct wholesale rates with laboratories, imaging centers, and pharmacies. These savings are passed on to patients, offering dramatic reductions on blood tests, X-rays, MRIs, and prescription medications.
In many cases, a complete lab panel that might cost hundreds through an insurance-billed facility can be obtained for under $50 through a DPC provider.
5. Whole-Person Care, Including Naturopathic Services
Many DPC practices, including GoodMed Clinic, incorporate naturopathic and integrative approaches into their care model. These services often include nutritional counseling, herbal medicine, lifestyle modification plans, and support for mental wellness.
By treating the whole person rather than just addressing symptoms, these services contribute to long-term wellness and disease prevention.
Why Direct Primary Care Is Not a Standalone Health Plan
Direct primary care is no health plan. While DPC provides tremendous value, it is important to understand its limitations:
DPC does not cover hospitalization, specialist care, surgery, or emergency services requiring advanced interventions.
It does not satisfy the Minimum Essential Coverage requirement under the ACA (though the individual mandate penalty has been removed in most states).
It is not a replacement for insurance in the case of catastrophic health events.
Instead, think of DPC as the foundation of a comprehensive healthcare strategy—a practical and affordable way to handle the majority of your day-to-day health needs, with other insurance products used as supplemental protection.
Who Should Consider Direct Primary Care?
Even though direct primary care is not a health plan, DPC can be a good fit for a wide variety of individuals and families, especially those looking for affordability, convenience, and personalized care. Below are some of the groups who may benefit most:
1. Uninsured or Underinsured Individuals
For those without insurance—or whose plans have extremely high deductibles—DPC provides a cost-effective way to access primary care without forgoing treatment or facing financial hardship.
2. Families Seeking Affordable, Consistent Care
Families with children often need frequent visits for preventive care, acute illnesses, and developmental concerns. DPC offers predictable costs and accessible care that supports the whole family.
3. Small Business Owners and Employees
Small businesses that cannot afford traditional group insurance plans can use DPC as an employee benefit, often pairing it with a lower-cost catastrophic insurance plan. This allows companies to offer meaningful coverage without breaking the budget.
4. Individuals with Chronic Illnesses
Patients managing long-term conditions such as diabetes, heart disease, or asthma benefit from the continuity, accessibility, and personalized attention that DPC provides.
5. Pre-Medicare Retirees
Adults who retire before becoming eligible for Medicare may face expensive private insurance premiums. DPC can provide a reliable source of care during this gap in coverage.
DPC in Seattle: Explore GoodMed Clinic
If you live in Seattle and are considering direct primary care alongside your health plan, GoodMed Clinic is a reputable patient-centered practice dedicated to whole-person wellness. GoodMed provides affordable memberships that include the following:
Comprehensive primary care services
Naturopathic and integrative care options
Same-day appointments and extended visit times
Discounted labs and prescriptions
Easy communication with providers by phone, email, or text
GoodMed’s approach reflects the core values of the DPC movement: care that is affordable, accessible, and deeply personal. If you are looking for a more affordable, transparent, and holistic addition to your conventional health plan, direct primary care may be the solution you’ve been searching for.
Schedule a consultation today with GoodMed Clinic, Seattle’s trusted provider of direct primary care.