What does a DPC membership cover?

Only the services stated in the signed membership agreement. A practice should identify included primary care services, exclusions, outside charges, access channels, response expectations, and cancellation terms before enrollment.

Does every DPC practice offer unlimited visits or same-day appointments?

No. Access and visit policies vary. A practice should promise only the availability it can reliably deliver and should state any visit, scheduling, communication, or after-hours limits in the agreement.

Does a DPC membership replace health insurance?

No. DPC is not health insurance. Patients remain responsible for hospital, emergency, specialty, imaging, surgery, and other care outside the membership agreement, using insurance or another payment method.

Can patients use HSA funds for DPC fees in 2026?

Beginning January 1, 2026, an otherwise eligible individual enrolled in certain qualifying DPC arrangements may contribute to an HSA, and periodic DPC fees may be reimbursed tax-free. For 2026, aggregate monthly fees generally cannot exceed $150 for one person or $300 when an arrangement covers more than one person for the arrangement not to affect contribution eligibility. Patients should confirm their facts with an HSA administrator or tax adviser.

What happens if DPC fees exceed the 2026 HSA limit?

IRS guidance says fees above the statutory arrangement limit may still be reimbursable from an HSA, but enrollment can disqualify the individual from making HSA contributions while covered. Splitting the payment between an HSA and another card does not change the arrangement's aggregate fee. Patients should obtain individual tax guidance.

How should a physician set a membership price?

Start with the services and access promised, expected utilization, capacity, staffing, complete operating costs, owner-compensation target, collection assumptions, and local demand. National ranges can provide context but cannot determine the right price for a specific practice.

Is DPC the same as concierge or cash-pay medicine?

No. DPC uses a recurring fee for defined primary care services without fee-for-service insurance billing for those covered services. Concierge practices may retain insurance billing, while direct cash-pay practices may charge per service without a recurring membership. The agreement controls the actual terms.

DPC Membership Model: Agreement, Pricing and HSA Rules

How does a DPC membership work?

A patient pays a recurring fee directly to a practice for the primary care services defined in a membership agreement. Covered services are not billed fee-for-service to a third-party payer. DPC is not health insurance, and services outside the agreement remain separate.

Write the promise down

The membership agreement must answer these questions

Who can enroll?

Define eligibility, age or household rules, employer-sponsored enrollment, and any geographic or panel limits.

What is included?

Name the primary care services covered by the recurring fee instead of relying on labels such as comprehensive or unlimited.

What costs extra?

Disclose fees for labs, medications, procedures, supplies, forms, or other services that are not included.

How does access work?

State office hours, scheduling rules, communication channels, expected response windows, and after-hours boundaries.

How does payment work?

Explain billing dates, discounts, failed payments, refunds, cancellation, reinstatement, and changes to the fee.

What remains outside the agreement?

Clarify that hospital, emergency, specialty, imaging, and other excluded care follow separate coverage and payment rules.

How is information handled?

Identify approved communication methods, privacy expectations, record access, and consent requirements.

Which legal rules apply?

Confirm state DPC law, insurance regulation, Medicare participation, scope of practice, and other practice-specific requirements with qualified advisers.

Price from the promise

A competitor's fee is context, not the answer

The price has to support the service scope, capacity, cost structure, and owner-compensation target of the actual practice. Use collected revenue after discounts, failed payments, refunds, and churn.

AAFP's 2024 DPC data brief reports $50-$100 monthly membership fees for individual adults. Freedom planning scenarios also test $75-$200 when market, scope, or access differs.

The services and access commitments written into the agreement
Expected utilization, visit design, communication workload, and panel capacity
Physician availability, staffing, coverage, and operating hours
The complete cost structure and owner-compensation target
Discounts, failed payments, refunds, churn, and collection timing
Local demand, affordability, competing offers, and employer terms

Compare the contract

DPC, concierge, and direct cash pay are not interchangeable

Market labels are inconsistent. Compare the payment structure, included services, insurance billing, exclusions, and termination terms in the actual agreement.

Direct Primary Care

A recurring fee for primary care services defined in a patient agreement.

Covered primary care services are not billed fee-for-service to a third-party payer. Outside care is separate.

Concierge medicine

A retainer or membership for services or access defined by that practice.

The practice may continue billing insurance for covered clinical services. Terms vary.

Direct cash pay

The patient pays directly for a visit, procedure, episode, or package.

A recurring membership is not required. Scope, price, and outside costs remain service-specific.

Federal HSA treatment

What changed for qualifying DPC arrangements in 2026

Beginning January 1, 2026, an otherwise eligible individual enrolled in certain qualifying DPC arrangements may contribute to an HSA, and periodic DPC fees may be reimbursed tax-free. For 2026, aggregate arrangement fees generally cannot exceed $150 per month for one person or $300 per month when an arrangement covers more than one person for the arrangement not to affect contribution eligibility.

Fees above those limits may still be reimbursable, but enrollment can disqualify the individual from making HSA contributions while covered. The aggregate arrangement fee controls; splitting payment methods does not change it. Patients should confirm individual eligibility with an HSA administrator or tax adviser.

DPC membership questions

Agreement scope, access, insurance, HSA, pricing, and model comparisons.

Primary references

The model definition and federal HSA statements are grounded in primary professional and government guidance. State law, Medicare status, agreement terms, and individual tax facts still require practice-specific review.

A DPC membership is a defined agreement. Not a universal package.