Defining Direct Primary Care (DPC)
As employers are searching for innovative ways to meet the needs of their team members, many business leaders are considering Direct Primary Care, or DPC. In the Direct Primary Care model, employees pay a flat monthly or annual fee for their primary care services. This differs from the traditional insurance billing process. Keep in mind – this does not cover all healthcare scenarios, such as more complex cases (surgery, specialists, etc.). According to SHRM.org, “Under a DPC model, employers contract directly with primary care providers for employee care and typically engage with insurance brokers for supplementary coverage for specialist and hospital care.” While it isn’t the right fit for every business, it’s certainly something for employers to consider. After all, healthy employees are happy employees!
Benefits of Direct Primary Care
- Personalized Care: Oftentimes, with DPC, doctors see fewer patients, allowing them to foster stronger relationships with patients. With the DPC model, they can even focus more on preventative care, reducing the need for expensive emergency visits.
- Accessibility: Individuals don’t have to avoid going to the doctor because they don’t want to pay that co-pay again. Patients can avoid surprise bills and feel comfortable visiting any time they need, especially for those with frequent primary care needs. Employers can also potentially reduce their overall healthcare spend with DPC.
- Speed: The DPC model usually can offer same-day or next-day appointments, with direct access to their doctors via visits or telehealth. This allows your employees to get the care they need, anywhere they need it from.
- Simplicity and Empowerment: DPC truly puts patients first and in control of their healthcare. When they don’t have to worry about insurance dictating coverage, patients and doctors can make choices based solely on medical needs. Not to mention that the uncomplicated nature of the model could lessen the burden on your HR teams.
Updates to DPC from the “One Big Beautiful Bill”
- HSA Eligibility: The “One Big Beautiful Bill” clarifies that individuals enrolled in a High-Deductible Health Plan (HDHP) can use HSA funds to pay for DPC arrangements without losing HSA eligibility. Now, Direct Primary Care is explicitly recognized as a medical service, rather than insurance, allowing tax-free HSA withdrawals for DPC payments. Individuals can use HSA funds to cover DPC subscriptions up to $150 per month for individual coverage and $300 per month for family coverage.
- Retroactivity: The DPC provisions take effect for tax years beginning after December 31, 2025. This gives individuals and employers time to plan for using HSAs to cover DPC fees, ensuring a smooth transition for those adopting or expanding DPC arrangements.
Here in the Quad Cities, we have benefits clients who have transitioned to Direct Primary Care, meaning there are providers right in your backyard. With its growing popularity and the recent legislative updates, now is the perfect time to consider DPC for your business. The benefits are evident with simplicity and wellness for both your employees and your leaders. If you’re interested in learning more, reach out to me at .
Written by: Jason White, Employee Benefits Sales Executive