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Patient tool · Prescriptions & bills

Direct primary care vs insurance-only calculator

Compare a direct primary care membership with paying for primary care through insurance alone.

Editorial review in progress · How we review

Uses 2026 figures
%
Direct primary care
$
$
With insurance only
$

Your copay, or the full cost if you haven't met your deductible.

$

Your results will appear here.
Adjust the numbers, then press Calculate.

Assumptions
  • From 2026, a DPC membership doesn't disqualify you from an HSA, and fees up to $150/month ($300 family) can be paid from it (P.L. 119-21).
  • Membership fees are not insurance premiums and don't count toward your deductible.
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Direct primary care (DPC) practices charge a flat monthly membership instead of billing insurance for each visit. This calculator compares a year of DPC with what you'd pay for the same primary care through insurance alone.

How it works

Enter the number of people, the monthly membership fee per person and what you'd spend on labs and generic medications at the DPC's prices.

For insurance-only, enter how many primary care visits your household has in a year, what you pay per visit (your copay, or the full cost if you haven't met your deductible), and what you'd spend on labs and generic medications.

  • DPC cost is the membership for everyone for 12 months, plus labs and medications.
  • Insurance-only cost is visits times your cost per visit, plus labs and medications.

If you'll pay the membership from an HSA, the calculator subtracts the tax you save, as long as the fee is within the 2026 limits ($150 a month for one person, $300 for a family).

Example

One person pays $85 a month for DPC and expects $80 in labs. With insurance only, they'd have five visits at $120 each and $300 in labs.

  • DPC: $1,020 + $80 = $1,100.
  • Insurance-only: $600 + $300 = $900.

Insurance-only is about $200 cheaper here. The break-even is about seven visits a year. Paying the membership from an HSA at a 30% tax rate saves about $306, which would make DPC about $106 cheaper.

Beyond the numbers

People often choose DPC for same-day access, longer visits and texting with their doctor. Those benefits don't show up in a cost comparison, but they can matter for managing ongoing conditions.

FAQ

Frequently asked questions

Does direct primary care replace health insurance?

No. DPC covers primary care, like visits, basic procedures and often discounted labs and medications. You still need insurance for specialists, hospital care, surgery and emergencies.

Can I have DPC and an HSA in 2026?

Yes. Starting in 2026, a DPC membership no longer makes you ineligible for an HSA, and fees up to $150 a month for one person or $300 for a family can be paid from the HSA.

What does DPC usually include?

Unlimited or generous office visits, longer appointments, direct messaging with your doctor, and wholesale-priced labs and generic medications. Each practice sets its own terms.

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