By: John Hsieh
Published: July 8th, 2025
Learn what services Direct Primary Care includes and where it stops. Understand how DPC works with or without traditional health insurance.
It’s easy to see why people mix them up. Both Direct Primary Care (DPC) and health insurance involve a monthly payment. Both offer access to healthcare services. And at first glance, they can feel similar.
But while the structure may look alike, DPC and insurance serve very different purposes.
That confusion is one of the biggest barriers to understanding how direct primary care actually works. In the next sections, we’ll break down how insurance is designed, how DPC fits in, and why they aren’t meant to do the same job.
Health insurance is designed to protect people from large, unexpected medical costs. It works by pooling money from many individuals to help cover major events like surgeries, hospitalizations, or chronic illness.
In that way, it’s a lot like car insurance. Car insurance doesn’t pay for oil changes or tire rotations. It covers accidents and repairs you cannot predict. Health insurance was created with the same idea in mind.
Over time, traditional health plans started to include coverage for routine care like doctor visits, check-ups, and labs. But that doesn’t mean they do it well. The system was not built to manage everyday healthcare, and trying to use it that way often leads to higher costs, limited access, and shorter appointments.
Insurance still plays an important role. But it was never meant to be the foundation for primary care.
Primary care is like routine maintenance for your health. Just as your car needs oil changes and inspections, your body needs checkups, lab work, and regular care to stay on track.
But under traditional insurance, doctors often have only 10 or 15 minutes per visit. That is not enough time to listen, understand, and treat. Imagine giving a mechanic 15 minutes to fix everything wrong with your car. It would not work, and neither does rushed primary care.
Direct primary care changes that. For a flat monthly fee, you get unlimited access to your doctor, longer visits, and same-day or next-day appointments. Because there is no billing per visit, your doctor can focus on care instead of paperwork.
What is included depends on the clinic. Some include labs, vaccinations, or medications in the membership, while others charge small additional fees.
DPC does not cover emergencies, hospital visits, or specialist care. You still need insurance or an alternative for major medical needs.
The model works because the incentives are different. In DPC, doctors are paid to keep you healthy. That leads to better care and better results.
Direct primary care covers most of your day-to-day health needs, but it does not replace insurance. You still need a way to pay for things like hospital stays, specialist visits, emergency care, and surgeries.
Many people pair DPC with a high deductible health plan. This keeps monthly insurance costs lower while still protecting against major medical expenses. Others who have more traditional plans may still choose to use DPC for better access, longer visits, and a stronger relationship with their doctor.
For individuals without insurance, DPC can still provide 80 to 90 percent of the care they need. Some also choose to use health cost-sharing options, like Sedera, as an alternative to traditional insurance.
The best setup depends on your situation. But no matter what your plan looks like, DPC can be a powerful part of your healthcare strategy.
With DPC now officially compatible with HSAs, there’s never been a better time to take control of your healthcare.
Join SALTA today or schedule a free consultation to see how Direct Primary Care can work for you.
John Hsieh is the Director of Growth at SALTA Direct Primary Care and the Michigan Chapter Lead for the Free Market Medical Association (FMMA). He is passionate about transforming healthcare through patient-centered models like DPC and works closely with employers, brokers, and clinicians to drive cost-effective, high-quality care.
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