What is Direct Primary Care?
Patients pay a recurring fee directly to a practice for defined primary care services without fee-for-service insurance billing for those covered services.
The operating change
What is Direct Primary Care?
How the model works
The American Academy of Family Physicians describes DPC as a model in which patients pay a periodic fee for a defined set of primary care services without fee-for-service billing to third-party payers for those services.
This can reduce claims-related work for membership-covered care, but it does not eliminate the work of operating a medical practice. Contracts, privacy, staffing, supplies, referrals, coverage, and state-specific compliance still require clear ownership.
DPC does not establish a universal panel size, visit length, response time, or access promise. Those commitments must follow the practice's actual scope and capacity.
Physicians moving from model evaluation to execution can review the DPC practice launch sequence, compare ongoing practice management, or see how DPC consulting extends beyond advice.
Fee. AAFP reports $50-$100 per month for individual adults; actual pricing varies by market, scope, and access.
Access. Appointment timing, communication channels, and response expectations belong in the written practice policy.
Capacity. Panel and visit design should follow service scope, staffing, physician availability, and membership price.
Scope. Included services, exclusions, outside charges, cancellation, and coverage expectations should be disclosed.
Insurance boundary. DPC is not insurance. Care outside the membership follows its own coverage and payment rules.
HSA treatment. Federal rules permit qualifying DPC arrangements beginning in 2026, subject to fee caps and individual eligibility.
DPC vs. insurance-based care
Compare the actual payment and operating structures. Neither label creates a universal patient experience.
Payment
Fee-for-service claims and patient cost sharing may apply
Recurring fee for services defined in the membership agreement
Included care
Determined by payer and practice rules
Stated in the practice agreement
Access
Set by the practice and payer network
Set by the practice's written access policy
Capacity
Often influenced by visit volume
Derived from scope, access, staffing, and price
Outside care
Subject to coverage and authorization rules
Still subject to separate coverage and payment rules
Compare the agreement, not the label
DPC vs. concierge medicine
The terms are used inconsistently. AAFP defines DPC around a recurring fee for defined primary care without fee-for-service billing for covered services. Some concierge practices retain insurance billing in addition to a retainer. Verify the fee, included services, exclusions, access terms, cancellation terms, and billing practices.
The honest tradeoff
DPC changes the payment model. It does not remove the work or risk of validating demand, funding a launch, setting capacity, meeting legal obligations, and operating a durable practice.
What physicians gain and still own
Potential operating gains
- Recurring revenue can be modeled from active members and collected fees
- The physician defines scope, access, capacity, and staffing
- Membership-covered care does not require fee-for-service claims
Owner responsibilities
- Validate demand, affordability, pricing, and enrollment pace
- Match the agreement to the services and access delivered
- Plan for capital, compliance, staffing, coverage, and outside care
Direct Primary Care questions
Key model, payment, and operating questions for physicians evaluating DPC.
Primary references
Model and federal tax statements are grounded in primary guidance. Pricing, panel, access, and launch assumptions vary by practice and market.
Evaluate Your DPC Practice Model
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