It is the single most common question about this model, and the answer is short.
No. A direct primary care membership is not health insurance, and it is not designed to take its place. The two cover different things. Most Ridgeview members carry both.
The longer answer is worth understanding, because how the pieces fit together affects what you pay and how you use your coverage.
Two different jobs
Think of it this way. Insurance exists to protect you from the costs you could never absorb on your own. A membership exists to make everyday care easy to get.
What a DPC membership generally handles
- Office visits with your physician, without a co-pay
- Preventive and annual visits
- Ongoing management of conditions like high blood pressure, high cholesterol and diabetes
- Acute problems: the cough that will not quit, the rash, the injury, the thing you would otherwise take to urgent care
- Direct communication with your doctor between visits
Our primary care page goes through these in more detail.
What insurance still handles
- Hospital stays and surgery
- Emergency care
- Specialist visits
- Advanced imaging such as MRI and CT
- Most lab work and prescription medications
- Maternity care, cancer treatment, and anything else that goes well beyond primary care
How members commonly pair the two
If you drop your insurance and keep only a membership, you are uninsured for all of the above. Please do not do that. If you don’t have or are unable to get health insurance, Ridgeview Direct Care will manage as much of your medical needs as possible and help you find the lowest-cost, high-quality services available for things like imaging and specialty care when you need them.
There is no single right combination, and what makes sense depends entirely on your plan, your budget and your health. A few patterns come up often.
Keep the plan you have
Many members change nothing about their coverage. They keep their employer plan for the big things and use the membership because getting in to see a doctor became the hard part.
A high-deductible plan plus a membership
If you are on a high-deductible plan, routine visits are often coming out of your pocket at full price until the deductible is met. Some households find that a predictable monthly fee for unlimited primary care fits that situation well. Whether it saves you money depends on your specific numbers, so it is worth doing the arithmetic rather than assuming.
Employers covering it for a team
Some small employers fund DPC memberships for employees alongside a plan, as a way to give people easier access to a physician. If that is the situation you are looking at, our small business page explains how it typically works.
A note on HSAs and FSAs
People ask constantly whether membership fees can be paid from a health savings account or flexible spending account. FSAs have always been ok, but the law was unclear on HSAs until 2025. Federal code now allows HSA funds to pay for DPC memberships for individuals and families up to certain limits. Ridgeview membership prices fall within federal limits for most families.
For more specific guidance on tax-exempt healthcare payments, please check with your plan administrator or a tax professional. We are physicians, not tax advisors, and this is one of those areas where a wrong assumption gets expensive.
What about referrals and the rest of the system?
If you need an orthopedic surgeon, a cardiologist, a gastroenterologist or a hospital, you still go, and your insurance still applies. Your physician refers you, sends the relevant history, and stays involved as the person who knows your whole picture.
Colorado has plenty of excellent specialists and hospitals. A membership practice works with them, not around them.
Questions to ask before you decide
- What is my deductible, and what do I currently pay out of pocket for a routine office visit?
- How many visits, urgent care trips and co-pays did my household actually use last year?
- Does my plan require a designated in-network primary care physician for referrals?
- If I am on Medicare or a Medicare Advantage plan, how does a membership practice fit with my coverage?
- Where will my labs and imaging be done, and what will they cost?
If you are not sure how to answer those, bring your plan details to a conversation and we will work through them together.
Talk it through with the doctor
Dr. Christopher Kroner offers a free 30-minute meet and greet at Ridgeview Direct Care in Wheat Ridge, serving Arvada, Lakewood, Golden, Edgewater and west Denver. If the honest answer for your household is that a membership does not make financial sense, you will hear that too.
Book a free meet and greet or call 720-807-9961.
This article is general education, not medical, insurance or tax advice. Please see our medical disclaimer.