Love DPC But Not Your Insurance Bill?
One of the most common things I hear from parents is:
“I love the Direct Primary Care model and would love to join, but I already pay so much for health insurance. I just can’t justify another monthly expense.”
If you’ve had that thought, you’re not alone.
As Direct Primary Care (DPC) has grown across the country, many families have started exploring alternatives to traditional health insurance plans. While there is no perfect solution for every family, some parents find that combining DPC with a different healthcare financing strategy can actually lower their overall healthcare costs while improving access to care.
Let’s take a look at some of the options families commonly consider.
High-Deductible Health Plans (HDHPs)
Many families choose to switch from a traditional insurance plan to a high-deductible health plan. These plans typically have lower monthly premiums in exchange for a higher deductible when care is needed.
Many HDHPs can be paired with a Health Savings Account (HSA), allowing families to set aside pre-tax dollars for qualified medical expenses. Current federal regulations allow most DPC membership fees to be eligible for HSA reimbursement.
Why families like this option:
- Lower monthly insurance premiums
- Continued protection against major medical expenses
- Ability to save pre-tax dollars in an HSA
- Often includes coverage for routine childhood vaccines
Think of it like car insurance: you pay for routine maintenance yourself, but you still have protection if something major happens.
Catastrophic Health Insurance Plans
Catastrophic plans are designed primarily to protect against serious illness or injury and generally have lower monthly premiums than traditional insurance plans. Eligibility rules vary, and these plans are often most attractive to younger, healthier individuals.
Coverage varies by plan, so it’s important to carefully review what preventive services and vaccines are included.
Why families like this option:
- Very low monthly premiums
- Protection from large, unexpected medical bills
- Can pair well with a DPC membership for routine care
If vaccines are not covered, some children may qualify for vaccination through the federal Vaccines for Children (VFC) program, depending on eligibility requirements.
Employer Plans Combined with Direct Primary Care
Some employers now offer DPC memberships as a benefit or encourage employees to combine DPC with a high-deductible or PPO insurance plan.
This approach allows families to maintain insurance coverage while enjoying the benefits of direct access to their pediatrician.
Why families like this option:
- Comprehensive insurance coverage
- Improved access to primary care
- Potentially lower out-of-pocket healthcare spending
- Some employers subsidize all or part of the DPC membership cost
As DPC continues to grow, more businesses are recognizing that easier access to primary care can improve employee satisfaction and reduce healthcare spending.
Health Sharing Ministries and Health Shares
Health shares are organizations whose members contribute monthly funds that are used to help cover eligible medical expenses within the community.
While many began as faith-based organizations, there are now a variety of health-sharing programs available throughout the country. These are not insurance plans, and coverage rules vary significantly between organizations.
Why families like this option:
- Lower monthly costs than many traditional insurance plans
- Flexibility in choosing healthcare providers
- Some health shares offer incentives or discounts when members use DPC practices
At Joyful Pediatrics, I currently have relationships with Zion HealthShare and Sedera Health. I’m always happy to explore partnerships with additional organizations when it benefits the families I serve.
Going Without Insurance
Some families choose not to carry health insurance and instead set aside money each month in a dedicated savings or investment account for future healthcare expenses.
This approach carries financial risk and is most beneficial for families without ongoing medical needs or concerns about unexpected emergencies.
Why families like this option:
- Complete control over healthcare spending
- No monthly insurance premiums
- Savings remain theirs if unused
It’s important to carefully consider the financial impact of a serious illness, hospitalization, or accident before choosing this route, but many small business owners (or families that work for small businesses) find this a cost-effective option.
Finding the Right Fit for Your Family
The reality is that there is no single healthcare solution that works for everyone.
Some families feel most comfortable keeping comprehensive insurance coverage. Others choose high-deductible plans, health shares, or alternative approaches. What matters most is finding a solution that balances your family’s budget, risk tolerance, and healthcare needs.
One thing I have noticed is that as Direct Primary Care continues to grow, more families are discovering that they don’t have to choose between affordable healthcare and accessible, personalized care.
If you’ve been curious about DPC but aren’t sure how it could fit into your family’s healthcare plan, I’d be happy to talk through the options and help you understand what might make the most sense for your situation.
