You have read enough about direct primary care to be interested, and enough to be a little suspicious. Every practice website describes the upside well, which is usually a sign that you are only seeing one half of the picture.
So here is the other half as well. Direct primary care suits some people very well and is a poor fit for others, and the difference usually comes down to how you actually use healthcare and what coverage you already have.
How the model works, in one paragraph
In direct primary care, you pay the practice a flat monthly membership fee, and the practice does not bill insurance for primary care visits. Removing billing codes and visit quotas from the arrangement is what makes longer appointments and direct contact with your physician possible. If you want the full version first, our guide to what direct primary care is walks through it step by step.
The pros patients notice first
These are the things members most often say made the difference for them.
- Access you can actually use. Members at Ridgeview can generally book same-day or next-day appointments for most needs, and reach the practice by phone, video, or secure message between visits. A question that comes up on a Tuesday in September does not have to wait for an opening in November.
- Visits that are not timed to the minute. Appointments are scheduled to take as long as the problem needs. That flexibility changes what a physician can notice and explain, and also changes how the visit feels. We wrote about why appointment length changes the medicine in more detail.
- Pricing you can see before you commit. At Ridgeview, founding membership rates are $129 for an individual and $199 for a couple, and children up to age 26 are $39 per month each. Current details are on the membership page.
- One physician who knows your history. Continuity is not a luxury feature. A doctor who remembers what your blood pressure did last spring, or how you responded to a medication two years ago, is working with better information.
- Small problems get handled while they are small. When asking a question is easy, people ask sooner. That is often the practical benefit patients mention first.
- Interactions can be in the office, over video, on the phone, or even through secure messaging. Without the need to give codes to insurance companies, DPC patients are not forced to come in just to create a “billable visit” and can be cared for in whichever way best fits the current need.
The cons and the trade-offs
None of these are hidden catches. They are simply how the model works, and they matter more for some households than for others.
- A membership is not health insurance. This is the most important one. A direct primary care membership covers primary care at the practice – and at Ridgeview, sports medicine evaluations as well. It does not cover hospital stays, surgery, emergency care, specialist visits or most imaging. You still need some coverage for more expensive costs at other facilities. Our post on how DPC and insurance work together goes through this carefully.
- You pay every month whether you use it or not. If you see a doctor once every three years and nothing about that is likely to change, a monthly fee may simply cost you money. Membership tends to earn its keep for people who use primary care at least a few times a year or who manage an ongoing condition.
- Not everything happens inside the fee. Labs, imaging, medications, procedures at other facilities and specialist care are generally billed separately or run through your insurance. What is included varies, so it is worth asking directly rather than assuming.
- A small practice is a small practice. One physician means genuine continuity, and it also means there are times when your doctor is away, and situations that are appropriately referred out to a specialist or a surgeon. That is ordinary medicine rather than a shortcoming, but it is worth expecting.
- It can overlap with something you already pay for. If you have a plan with a low primary care copay that you are happy with, a membership may duplicate part of what you already have. That is a real consideration and a reasonable reason to decide against it.
- The tax and reimbursement picture is not simple. Whether a membership fee can be paid from an HSA or FSA, and how it interacts with your plan, depends on current rules and on your specific plan. Please check with your plan administrator and a tax professional rather than relying on general guidance, including ours.
Who tends to find it a good fit
Patterns we see often, though every situation is different:
- People managing an ongoing condition such as high blood pressure, high cholesterol or diabetes, where regular review and easy contact genuinely change the care.
- Families with young children, where the questions are frequent and often feel urgent. Ridgeview also sees children through its pediatric care.
- People on high-deductible plans who are already paying out of pocket for routine care.
- Self-employed people and small business owners, for whom access problems carry a direct cost in lost working days. There is more on the small business page.
- Active adults with recurring joint or tendon pain who want an unhurried musculoskeletal evaluation rather than a referral loop.
Who may want to think harder first
- People who rarely see a doctor and have no ongoing concerns.
- Anyone whose budget is already stretched by premiums, where a monthly fee on top would be a strain.
- People whose care is directed mostly by specialists rather than by a primary care physician.
- Anyone who would be tempted to drop insurance coverage in order to afford a membership. That is a trade we would not recommend to anyone.
Questions worth asking before you join anywhere
Practices are set up differently, so ask plainly and write the answers down.
- What is included in the monthly fee, and what is billed separately?
- How do I reach the physician after hours, and what happens when they are away?
- How are labs and imaging handled, and can I use my insurance for them?
- What happens when I need a specialist, surgery or the hospital?
- Is there a contract term, and how do I leave if it is not working for me?
A meet and greet is a good place to ask all of these. Here is what actually happens at one.
Decide with better information
Dr. Christopher Kroner, MD MPH, has practiced family and sports medicine since 2013, including twelve years of full-time academic practice training medical students, residents and fellows. Whether this model fits you depends on details that are easier to talk through than to read about. If you are still weighing it up, our look at who DPC suits is a useful companion to this one.
Ridgeview Direct Care is at 4045 Wadsworth Blvd #300 in Wheat Ridge, open Monday through Friday, and serves patients from Arvada, Lakewood, Golden, Edgewater and west Denver. A direct primary care membership is not health insurance.
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 advice. Please see our medical disclaimer.