You open the benefits portal in November, look at the high deductible plan, and do the mental arithmetic: the premium is manageable, but the deductible means that for most of the year you are effectively paying cash for anything routine. So you skip the sore throat, put off the blood pressure follow-up, and hope nothing becomes a problem.
That gap between what the plan covers and what everyday life actually needs is the reason so many patients end up pairing a high deductible plan with a direct primary care membership. Here is how the two fit together, and how to work out whether the combination makes sense for you.
Why these two get paired so often
A high deductible plan is built for the big, rare, expensive things. Surgery. A hospital admission. A serious diagnosis. It is a reasonable product for that job.
What it handles less gracefully is the small and frequent: the visit about a rash, the medication adjustment, the ache that needs looking at, the question you would ask if asking were easy. Those visits land in the deductible, so they feel expensive, so people ration them.
A membership addresses the frequent and ordinary. The plan addresses the rare and catastrophic. Used together, each does the job it is actually designed for.
The 2026 numbers that frame the decision
For a plan to count as a high deductible health plan in 2026, the IRS set the minimum deductible at $1,700 for self-only coverage and $3,400 for family coverage. The out-of-pocket maximums for those plans are capped at $8,500 and $17,000 respectively. HSA contributions for 2026 are limited to $4,400 self-only and $8,750 family, with an extra $1,000 allowed from age 55.
Those are floors and ceilings, not what your plan actually is. Many real plans carry deductibles well above the minimum. Use your own plan documents for the numbers that matter to you, because the gap between the legal minimum and your actual deductible is often where the decision gets made.
What the membership covers before the deductible is in play
At Ridgeview, a primary care membership covers the primary care relationship itself: preventive care and physicals, acute illness and injury visits, ongoing management of chronic conditions, sports medicine consultations, and direct access to Dr. Kroner. Follow-up can happen in person, by video, by phone or by secure message, and the membership cost does not change based on which one you use.
The individual membership is $99 per month at the founding rate and $129 standard. Two adults in the same household are $179 founding and $199 standard, with children up to age 26 at $39 per month each. The primary care page has the full detail, and our post on what is included and what is not goes line by line.
What the plan still has to carry
This is the part worth being blunt about. A direct primary care membership is not health insurance. The membership does not pay for:
- Hospital stays and emergency care
- Surgery and anesthesia
- Specialist visits and specialty treatment
- Advanced imaging done elsewhere, such as MRI or CT
- Prescriptions at the pharmacy counter
- Outside lab and pathology charges
Keeping coverage for those is not optional in any practical sense. We walked through the relationship in how direct primary care and insurance work together.
Running your own math honestly
Skip the generic calculators. Pull last year’s actual use and work from that:
- Count the primary care visits your household had, including the ones you went to urgent care for because you could not get in anywhere else.
- Add the visits you skipped and wish you had not. This number is usually the honest one.
- Find what each of those visits cost you against the deductible, not the sticker price.
- Add twelve months of membership plus the one-time registration fee, so you are comparing a full year to a full year.
- Leave the catastrophic column alone. It belongs to the insurance either way and should not move in this comparison.
Where the pairing tends to work well
Many patients in these situations find the combination fits:
- A high deductible you realistically never meet, so routine care is already cash
- One or two chronic conditions that benefit from frequent, unhurried follow-up
- Self-employed or small-business households buying their own coverage
- Families with children who need to be seen promptly and often
- People who have been putting off care because scheduling it is a chore
Where it tends not to
It is a worse fit when:
- You already have a rich low-deductible plan with inexpensive primary care copays
- Your care is mostly delivered by specialists rather than primary care
- A fixed monthly cost would strain the budget on top of premiums
- You rarely see a doctor and are content with that
Our honest look at who direct primary care suits goes further into the cases where the answer is no.
The HSA piece changed this year
Until recently, a membership could complicate HSA eligibility, which made this pairing awkward. For months beginning after December 31, 2025, a qualifying direct primary care arrangement no longer blocks HSA contributions, and the fees can generally be paid from the account, as long as the monthly fee stays within the caps of $150 for an individual and $300 at the family level for 2026.
We went through the details, including what happens above the caps and how FSAs differ, in whether you can use an HSA or FSA for direct primary care. As with anything touching your return, confirm the specifics with your tax professional and your plan administrator rather than relying on a blog post, including ours.
A few questions to take to open enrollment
Before you choose a plan for next year, it is worth having answers to these:
- What is my actual deductible, and what counts toward it?
- Is the plan HSA qualified, and what will my employer contribute?
- What do primary care visits cost me before the deductible is met?
- Does the plan require a referral from an in-network primary care physician?
- What is my out-of-pocket maximum if a bad year happens?
That last one matters more than people expect. For benefits questions specific to your coverage, your plan administrator is the authority, not us.
Think it through out loud
If you want to sit down and look at how a membership would work alongside your plan, that is exactly what a meet and greet is for, and there is no obligation attached to it. Book a free 30-minute meet and greet with Dr. Kroner or call 720-807-9961. Ridgeview Direct Care is at 4045 Wadsworth Blvd #300, Wheat Ridge, CO 80033, open Monday through Friday, serving Arvada, Lakewood, Golden, Edgewater and west Denver.
This article is for educational purposes only and is not medical, tax, insurance or legal advice. Please confirm coverage questions with your plan administrator and tax questions with your tax professional. See our medical disclaimer.