You have heard a friend rave about being able to text her doctor. You have also looked at your own bank statement and wondered whether one more monthly charge makes any sense when you already pay for health insurance. Both reactions are reasonable.
So is direct primary care worth it? For some people, clearly yes. For others, probably not, at least not right now. The honest answer depends on how you use healthcare, what your insurance looks like, and what you value in a doctor relationship. This guide walks through both sides so you can decide for yourself.
First, a quick refresher on what you are paying for
Direct primary care (DPC) is a membership model. You pay your primary care practice a flat monthly fee, and in exchange you get ongoing access to your physician without a bill for each visit. If you want the full background, our plain-English guide to direct primary care covers the basics.
One point matters more than any other: a DPC membership is not health insurance. It covers everyday primary care. It does not cover hospital stays, surgery, emergency care, specialist visits or advanced imaging. Most people who join a membership practice keep insurance or subscribe to a health share for those things, and we recommend that you do too.
At Ridgeview Direct Care in Wheat Ridge, membership rates are $129 a month for an individual and $199 a month for two adults in the same household, with children up to age 26 at $39 a month each. There is also a one-time registration fee, listed on our primary care page.
The question behind the question
When people ask whether DPC is worth it, they are usually asking one of two things:
- Will it save me money?
- Will it make my healthcare better or easier?
Those are different questions, and the answers do not always line up. Some members join mainly for access and relationship, and they are comfortable paying for that. Others need the numbers to work before anything else. Knowing which camp you are in makes the decision much simpler.
Who direct primary care tends to suit
There is no single profile, but a few situations come up again and again.
People who actually use primary care
If you have a chronic condition such as high blood pressure, diabetes or high cholesterol, you likely need regular check-ins, medication adjustments and lab review. Under a traditional plan, each of those visits may come with a co-pay or, on a high-deductible plan, the full cost of the visit until your deductible is met. A flat membership can make that ongoing care more predictable.
Families juggling several schedules
Kids get ear infections, rashes, and sports injuries at inconvenient times. For households where someone always seems to need a doctor, having same-day or next-day appointments and a physician you can reach directly can take a lot of friction out of the week. Our pediatrics page explains how Ridgeview cares for children and teens.
Active adults and weekend athletes
This one is specific to Ridgeview. Dr. Christopher Kroner is a family practice and sports medicine physician, and sports medicine consultations are included in membership. If you run, ski, climb, or play a sport, having one doctor who handles both your everyday health and your sore knee can be a real convenience. You can read more on our sports medicine page.
People on high-deductible plans
If your insurance mostly exists for the big, unexpected things, you may be paying full price for routine visits anyway. Some people find that pairing a high-deductible plan with a membership gives them predictable everyday care plus protection for major events. Whether that adds up for you depends on your plan, so it is worth running your own numbers.
Anyone tired of not being able to reach their doctor
Some of the value is hard to put in a spreadsheet. Being able to message your physician about a new symptom, hear back from the person who knows your history about whether it needs a visit, and see the same doctor every time is what draws many people to this model.
Who it may not suit, at least for now
Honesty cuts both ways. Here are situations where a membership may not be the right fit.
- You rarely see a doctor. If you are healthy, visit a physician once every couple of years, and your insurance covers your annual preventive visit with no cost to you, a monthly fee may not add much value right now.
- Your current primary care works well for you. If you can get in when you need to, your doctor knows you, and your costs are manageable, there may be no problem to solve.
- Your plan requires a designated in-network primary care physician. Some plans, including most HMOs, route specialist referrals through an assigned PCP. A membership can still work alongside those plans, but it may complicate certain aspects of care. Check with your plan administrator.
- You are enrolled in Medicaid. Some states, currently including Colorado, do not allow Medicaid recipients to pay privately for services covered by Medicaid. Other states have no problem with it.
How to run your own numbers
You do not need a complicated formula. Pull up last year and answer a few questions:
- How many primary care and non-surgical orthopedic visits did your household have, and what did you pay out of pocket for each?
- How many urgent care visits did you make for things a primary care doctor could have handled?
- What is your deductible, and how often do you actually reach it?
- What is your monthly premium, and would you keep the same plan if you joined a membership?
Add up what you spent on everyday care and compare it with a year of membership. Then ask yourself how much the harder-to-measure parts are worth to you: shorter waits, longer visits, and a doctor who answers the phone.
For questions about HSAs, FSAs or how membership fees are treated for tax purposes, please check with your plan administrator or a tax professional. The rules can depend on your specific plan and situation.
What a membership will not do
Setting realistic expectations is part of deciding well. A DPC membership does not replace a specialist when you need one, does not cover a hospital stay, and does not make an emergency department unnecessary. For chest pain, trouble breathing, signs of stroke or any other emergency, call 911 or go to the nearest emergency department.
What it can do is give you a physician who knows your history, has time to talk through your concerns, and helps coordinate with specialists and hospitals when you need them.
The easiest way to find out
Reading about a model only gets you so far. The next step is a conversation. At a meet and greet you can ask about your specific situation, your insurance, and whether membership makes sense for your household. If it does not, you will hear that too. Here is what actually happens at a free meet and greet, so you know what to expect.
Ridgeview Direct Care is at 4045 Wadsworth Blvd #300 in Wheat Ridge, open Monday through Friday, and serves patients from Arvada, Lakewood, Golden, Edgewater, Denver and surrounding areas.
Book a free 30-minute meet and greet with Dr. Kroner or call 720-807-9961.
This article is for general educational purposes only and is not medical, insurance or financial advice. Please see our medical disclaimer.