11/05/2025, written by Camila Fox Gonzalez
The Dangers of Direct Primary Care Without Insurance
As health care costs rise and insurance premiums continue to climb, many Americans are looking for cheaper, more predictable alternatives to traditional coverage. Direct Primary Care (DPC) is being marketed as a “simple” solution — pay a flat monthly fee and get unlimited access to your primary care doctor. But what most people don’t realize is that DPC is not insurance. And relying on it alone can leave families dangerously exposed to massive medical bills, denied care, and financial crisis during moments when they need protection most.
What is Direct Primary Care?
Direct Primary Care (DPC) is a health care model where patients pay a membership fee directly to a primary care provider in exchange for primary care services. This fee is typically monthly, quarterly, or annual. The idea is that the insurance middleman is removed.
Most DPC memberships usually include:
Sick visits
Basic lab work
Physical exams
Telehealth
Fast scheduling + longer visits
Chronic care management
However, it’s important to understand what DPC does not cover.
What is NOT included in DPC?
Specialist care (cardiology, dermatology, endocrinology, etc.)
Hospitalizations
Emergency room care
Imaging (MRI, CT, Ultrasound, X-ray)
Surgery (outpatient or inpatient)
Obstetrics
Procedures outside the DPC office
DPC is not designed to replace health insurance. Even the American Academy of Family Physicians recommends that DPC be paired with a high-deductible health plan, not used as a standalone coverage plan.
Why is this concerning right now?
Most of the information available online about Direct Primary Care comes from:
American Academy of Family Physicians
DPC Frontier
DPC Coalition
These groups actively lobby at the state + federal level to grow DPC models, but they are not patient advocacy organizations. Their perspective is financially incentivized to expand DPC practices.
The misleading price structure of DPC.
According to Healthinsurance.org:
Children: $20–$75 per month
Most adults: $50–$100 per month
Older adults: up to $150 per month
That sounds cheaper than insurance, but remember:
You still have to pay full price out-of-pocket for anything outside of primary care.
That includes:
Emergency room
Surgery
Specialists
Hospital stays
Any serious, unexpected health event
What happens when people go without insurance?
Most uninsured people are in low-income families. Adults ages 19-64 are more likely to be uninsured than children. Racial and ethnic disparities in coverage persist.
Already most uninsured adults don’t have coverage due to cost, no access to coverage through their jobs, live in red states without expanded Medicaid, are ineligible for or unaware of subsidized Marketplace coverage.
49% of uninsured adults have difficulty affording health care costs compared to 21% of adults with private insurance.
Most people who are uninsured have low or moderate incomes, little to no savings.
62% of uninsured adults have medical debt compared to 44% of insured adults.
46.6% of uninsured adults didn’t see a physician or get care in the past 12 months compared to 15% with private insurance and 14 & with public coverage.
The systemic impact: Adverse Selection
When healthier individuals decide they don’t need insurance because they’re using DPC instead, the insurance risk pool becomes sicker and more expensive. This drives up costs for everyone else who does remain insured.
That means DPC-only models don’t just harm the individual choosing it.
They make premiums higher for the entire population.
Bottom line
Direct Primary Care can be a great supplemental option… when paired with actual insurance.
But choosing Direct Primary Care instead of insurance is extremely risky for you financially and medically, and it drives up the cost of healthcare for everyone.
DPC is primary care access, not protection from catastrophic health events.
You still need real health insurance.