What Is Direct Primary Care
If you're looking into direct primary care, you likely want to:
Give employees real access to a doctor, not just an insurance card.
Keep routine care from turning into expensive claims.
Know whether it works alongside the health plan you already have.
Most health plans give employees a card and a deductible. On paper they're covered. In practice, a routine visit before the deductible costs $100 to $250, so people wait. The sinus infection becomes an urgent care visit. The blood pressure nobody checked becomes a prescription, then a specialist, then a claim.
In our experience, the problem usually isn't coverage. It's access. Employees have insurance they're afraid to use and a doctor they can't get in to see for three weeks.
Direct primary care (DPC) fixes the access problem. This guide covers how it works, what it costs, and when it makes sense for an employer.
BenefitSmart is a nonprofit that helps employers make sense of their benefits options. Book a free Benefits Review to see whether direct primary care fits your team.
1. Understand how direct primary care works
Direct primary care is a membership. The employer (or employee) pays a flat monthly fee directly to a primary care practice. In exchange, members get unlimited primary care with no copays and no claims filed.
Because the practice isn't billing insurance, it can keep patient panels small. Many DPC doctors run full practices with a few hundred to about 700 patients, according to a 2026 DPC Alliance survey, compared with 2,000 or more in a traditional practice. That's what makes same-day visits and direct texting possible.
Most memberships include:
Same-day or next-day visits, in person or virtual.
Direct phone and text access to the physician.
Longer appointments, often 30 to 60 minutes.
Wholesale labs and generic medications, often at a fraction of retail.
Chronic condition management for diabetes, blood pressure, and similar ongoing care.
2. Know what direct primary care is not
Direct primary care is not health insurance. It doesn't cover hospital stays, surgery, specialists, or emergencies. Employees still need a major medical plan for those.
That's why most employers pair DPC with their existing plan rather than replacing it. The DPC membership handles everyday care. The health plan handles the big, unpredictable events.
It's also different from telehealth. Telehealth connects employees with whichever doctor is available. DPC gives them the same doctor every time, one who knows their history.
3. Know what it costs
DPC memberships now average about $98 per member per month, though prices vary with panel size: smaller practices tend to charge more. Children's rates are usually lower, and some practices offer employer rates or family caps.
For employers, the math usually comes down to three questions:
How much routine care currently runs through your health plan? Every primary care visit, lab, and generic prescription handled by DPC is one your plan doesn't pay.
How is your plan funded? Self-funded and level-funded employers see lower claims directly. Fully insured employers see the benefit more slowly, through better claims history at renewal.
Will employees actually use it? DPC only saves money if people use it instead of urgent care or the ER.
Direct primary care now works with HSAs. Starting in 2026, federal law allows DPC memberships alongside a health savings account, with monthly fees up to $150 for an individual and $300 for a family. That removes one of the biggest barriers for employers on high-deductible plans.
4. Decide if it fits your organization
DPC works best when:
There's a DPC practice near your employees. Availability varies widely by region, so this is the first thing to check.
Your team underuses care because of cost, especially on high-deductible plans.
You have employees managing chronic conditions who would benefit from consistent follow-up.
You're self-funded or level-funded and can see savings from lower claims directly.
It's a harder fit when employees are spread across many locations with no nearby practices, or when most of your team already has a primary care doctor they're happy with.
Direct primary care: access your employees will actually use
The usual way to control healthcare costs is to make the plan harder to use: higher deductibles, narrower networks, bigger premium shares. Direct primary care goes the other way. It makes everyday care easy enough that problems get handled while they're still small and cheap.
It's not the right fit for every employer, and it doesn't replace your health plan. But for the right workforce, it can mean better care and fewer claims at the same time.
Want to know if it makes sense for your team? BenefitSmart's free Benefits Review looks at your current plan, where your employees are, and how they use care, then tells you whether DPC, or something else, is worth pursuing. Book your Benefits Review.
