Is DPC Right for Me?
Most people hear about Direct Primary Care and have the same question: what is this, how does it work, and would it actually make sense for me?
This page answers that honestly - including the math.
This calculator helps estimate and compare the potential cost of different healthcare approaches, including traditional insurance, Direct Primary Care (DPC), and health sharing programs.
Enter your estimated monthly costs to see how different options compare over the course of a year. Estimated cost ranges and a glossary of terms are listed below the calculator.
What is Direct Primary Care?
Direct Primary Care (DPC) is a membership-based primary care model where patients pay a simple monthly fee for ongoing access to their doctor, instead of paying per visit through traditional insurance.
Your DPC membership typically covers:
Primary care visits without additional office visit fees
Same or next-day appointments for urgent concerns when available
Direct communication with your physician (secure messaging, phone, or telehealth)
Longer, unhurried visits focused on prevention and chronic disease management
How Does DPC Work With My Other Coverage?
DPC covers the care you use most: primary care visits, chronic disease management, same-day appointments. It does not cover hospitalizations, surgeries, or major unexpected medical events. For that, you still need something. Here are your three main options:
Option 1: Keep your current insurance and add DPC.
This is the simplest move. You keep your existing coverage and add DPC on top for better everyday care. It costs more monthly, but makes the most sense if your employer subsidizes your premium heavily.
Option 2: Drop to a high-deductible or catastrophic plan and add DPC.
Since DPC handles your routine care, you may not need a rich plan anymore. A catastrophic plan covers the big stuff at a much lower monthly premium. You're self-insuring the middle, which is less intimidating when you have a DPC physician available any time.
Option 3: Pair DPC with a health share.
Health shares are not insurance, but they're a way for members to share each other's medical costs. They're often significantly cheaper than traditional insurance and work well alongside DPC because most routine care is handled directly through your membership.
None of these is right for everyone. The calculator below will show you how the numbers compare for your specific situation.
Run Your Numbers
Enter your real numbers and see if you would save any money switching to DPC. If you have a really generous employer plan or rarely see a doctor, the math may not work in your favor.
Enter your insurance details
ACA insurance details
Direct Primary Care costs
Estimates for ACA Marketplace pricing
ACA marketplace plans are health insurance policies purchased through the Health Insurance Marketplace and often include monthly premiums, deductibles, and copays for medical visits.
Many individuals end up paying between $200 and $400 a month after subsidies, but it could be less if they qualify for more assistance. On the high end, some plans without subsidies can exceed $600 or $700 a month.
Typical primary care visit pricing
Many ACA plans still require copays or deductible payments for primary care visits. A conservative estimate for a primary care visit is between $120-$180. Most adults see a doctor 3-5 times a year, leading to $400-$800 annually in out-of-pocket primary care costs.
What Is a Health Share?
A health sharing program is a membership-based community where members contribute a monthly amount that helps cover eligible medical expenses for other members. Health shares are not insurance, and have their own rules and eligibility requirements. Many people use them as a lower-cost option for covering larger or unexpected medical expenses. Typical monthly contributions range from about $100–$350 for an individual, depending on the program and age of members.medical expenses such as hospitalizations, surgeries, or specialist care. You can learn more about Health Shares here.
Important calculator disclaimer
This calculator compares insurance premiums and primary care visit costs only. It does not estimate potential savings from medications, specialist care, emergency services, or hospitalizations. Actual costs will vary based on your specific plan, health needs, and how you use care. Always review program details carefully before enrolling. This tool is for general education and should not be used as financial, insurance, or medical advice.
Why Insurance Often Doesn’t Fully Cover Primary Care Costs
Even with health insurance, many patients still pay part of the cost for primary care visits.
This happens for a few common reasons:
Deductibles must be met first
Many insurance plans require patients to pay for medical visits themselves until their deductible is reached. This means the full negotiated price of a primary care visit may apply early in the year.
Copays and coinsurance still apply
Even after meeting a deductible, most plans require a copay (a fixed fee) or coinsurance (a percentage of the visit cost) for each appointment.
Not all visits count as preventive care
Insurance often covers certain preventive services, like annual wellness visits, at no cost. However, visits for illness, ongoing conditions, medication management, or additional concerns may be billed differently and involve out-of-pocket costs.
Costs vary between plans and networks
Different insurance plans have different copays, deductibles, and provider networks, which can affect how much a patient pays for the same type of visit.
Insurance is primarily designed for larger medical expenses
Most insurance plans are structured to protect patients from very high medical costs such as hospitalizations or surgeries. Routine healthcare like primary care visits may still involve out-of-pocket costs.
Email Yourself Your Results
We’ll send a simple summary of your ACA vs. Direct Primary Care estimate to your inbox so you can review it later or share it with family.
By submitting your email, you agree to receive a one-time summary of these calculator results. We won’t use it for marketing without your permission.
Insurance Terms Explained
Premium
The amount you pay every month to have health insurance coverage, even if you do not use any services.
Deductible
The amount you must pay out of pocket for healthcare services before your insurance starts paying for most covered services.
Copay (Copayment)
A fixed amount you pay for a healthcare visit or service. For example, a $40 copay for a primary care visit.
Coinsurance
A percentage of the cost you pay for a medical service after your deductible has been met. For example, if your coinsurance is 20%, you pay 20% of the visit cost and the insurance company pays the rest.
Out-of-Pocket Maximum
The most you will have to pay for covered healthcare services in a year. After reaching this limit, your insurance typically pays 100% of covered services for the rest of the year.
Preventive Care
Certain screenings, vaccines, and annual wellness visits that insurance plans often cover at no cost to you when performed by an in-network provider.
Network
The group of doctors, hospitals, and healthcare providers that have contracts with your insurance company. If you see a doctor outside the network, it may cost you more.
Primary Care Visit
A visit with a primary care physician or provider for routine care, management of chronic conditions, minor illnesses, or general health concerns.
Marketplace (ACA Marketplace)
A government-run website where individuals and families can compare and purchase health insurance plans if they do not receive coverage through an employer.
Subsidy (Premium Tax Credit)
Financial assistance provided by the government to help lower the monthly cost of marketplace insurance for people who qualify based on income.
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Moon Hill Family Medicine | 2980 N Swan Rd Suite 225 | Tucson, AZ 85712
(520) 276-6255 | moonhillfamilymedicine.com | [email protected]
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