Quick Answer
Yes, in most cases you still need insurance with direct primary care. Direct primary care covers a defined set of primary care services, but it is not health insurance. You will still want coverage for emergencies, hospital stays, specialists, surgery, advanced imaging and many prescriptions and lab tests. Many people pair a direct primary care membership with an insurance plan that fits how they use care.
Who this is for: adults considering direct primary care who want to understand how it fits with their health insurance.
What a Direct Primary Care Membership Covers
Direct primary care memberships typically cover office visits, sick visits within the practice’s scope, preventive care, management of common chronic conditions and access to your provider between visits, all for a recurring fee paid directly to the practice.[1] Each practice defines exactly what is included, and some services, such as certain labs, procedures or medications, may cost extra.
What It Does Not Replace
A direct primary care membership does not pay for care outside the practice. Insurance is still important for:
- Emergency room visits and ambulance transport
- Hospital stays and surgery
- Specialist visits
- Advanced imaging, such as MRI and CT scans
- Many prescription medications
- Cancer care and other major medical needs
Without insurance, a single serious illness or injury can lead to very large bills.
Direct primary care covers everyday care. Insurance covers the rest.
How People Combine Direct Primary Care and Insurance
Many members keep the insurance they already have, whether through an employer, the marketplace or Medicare, and use direct primary care for their everyday care. Others choose a plan with a higher deductible and lower premium, using direct primary care for routine needs and insurance for larger expenses. The right combination depends on your health, budget and how often you use care.
Health savings accounts
Under a federal law change, beginning in 2026, direct primary care membership fees within certain monthly limits can be paid with a health savings account and no longer automatically disqualify someone from contributing to an HSA. Rules and limits apply, so check with your HSA administrator or a tax professional about your situation.
Medicare
If you have Medicare, ask the practice how membership works with your coverage, since rules for practices that do not bill Medicare are different.
Questions to Ask Before Joining
- What services does the membership include, and what costs extra?
- How are labs and medications priced?
- How does the practice coordinate with specialists, hospitals and my insurance plan?
- Does the practice bill insurance or Medicare for anything?
- Can I use an HSA or FSA to pay for membership?
- What is the cancellation policy?
How Membership Works at Lake Forest Regenesis
Lake Forest Regenesis offers a Direct Primary Care membership for adults with Allana as your primary care provider. Membership covers primary care services within the clinic’s scope and is paid directly to the clinic. The clinic does not bill Medicare, and some services are separate from membership, so the team can walk you through what is included and how it may fit with your insurance before you join.
When to See a Provider
Direct primary care is not a substitute for emergency care or insurance. Call 911 or go to the nearest emergency room for chest pain, trouble breathing, signs of stroke, severe bleeding or other emergencies.
Wondering how membership fits with your insurance? We can walk you through what Direct Primary Care covers and what it doesn’t.
Frequently Asked Questions
Is direct primary care a type of health insurance?
No. It is a membership for primary care services. It does not cover hospital, emergency or specialist care.
Can I use my insurance at a direct primary care practice?
It depends on the practice. Many do not bill insurance for membership services, though your insurance may still cover labs, imaging or prescriptions ordered by your provider.
Can I pay for direct primary care with an HSA?
Beginning in 2026, federal rules allow direct primary care fees within certain limits to be paid with an HSA. Check with your HSA administrator for details.
Is direct primary care worth it if I rarely see a doctor?
It depends on what you value, such as prevention, easy access and continuity. Comparing the membership cost with how you use care can help you decide.
References
- American Academy of Family Physicians. Direct primary care. Read the policy
This article is for general education and is not a substitute for individual medical advice. See our medical disclaimer.
