Direct Primary Care vs Health Insurance: The Real Math
If you’re a healthy adult or family paying $400+/month for insurance you barely use, this page will save you money. We ran the numbers so you don’t have to.
The TL;DR
Traditional insurance: $5,720 – $14,450 per year for an individual or family. Premium + deductible + copays.
Garcia Family Medicine DPC: $1,188 – $2,700 per year. No deductible, no copays.
Savings: $3,020 – $11,750 per year, before factoring in better access and care quality.
What You Actually Pay — Healthy Individual, Age 35
| Cost | Traditional Insurance | DPC + Catastrophic Plan |
|---|---|---|
| Premium | $4,800/year ($400/mo) | $99/mo DPC = $1,188 + $1,800/year cat. plan |
| Deductible if used | $3,000–6,000 | $5,000–7,000 (rarely hit) |
| Copays (4 visits/year) | $120–300 | $0 |
| Year 1 (healthy) | $4,920–5,100 | $2,988 |
What You Actually Pay — Family of Four
| Cost | Traditional Insurance | DPC + Catastrophic Plan |
|---|---|---|
| Premium | $14,400/year ($1,200/mo) | $225/mo DPC = $2,700 + $4,200/year cat. plan |
| Deductible if used | $5,000–12,000 | $10,000–14,000 |
| Copays (12 visits/year) | $360–900 | $0 |
| Year 1 (mostly healthy) | $14,760–15,300 | $6,900 |
What’s Actually Covered
| Service | Traditional Insurance | DPC + Catastrophic |
|---|---|---|
| Primary care visit | Copay + counts to deductible | Unlimited, $0 |
| Same-day appointment | Sometimes available | Standard |
| 30–60 minute visits | Almost never | Standard |
| Text/call your doctor | Almost never | 24/7 direct access |
| Labs and bloodwork | Lab markups, billing surprises | Wholesale pricing |
| Hospitalization | Yes (after deductible) | Yes — via cat. plan |
| Specialist visits | Yes (after deductible) | Yes — via cat. plan |
Where DPC Falls Short
DPC isn’t a complete healthcare solution by itself. You need a catastrophic health plan paired with your membership to cover: hospitalizations, specialist care, surgery, and ER visits.
We recommend a high-deductible health plan (HDHP) from the ACA marketplace or your employer. These typically run $150–350/month for an individual or $350–700/month for a family — significantly less than traditional comprehensive insurance because you’re not paying twice for primary care.
Who DPC Is Best For
- You pay your own premiums (self-employed, gig worker, retired before Medicare)
- You have a high-deductible plan and rarely hit it
- You’re generally healthy and want more access, not less
- You have a chronic condition that benefits from longer visits
- You’re tired of insurance hassle, copays, and rushed care
Common Questions
Can I use HSA/FSA for DPC?
Yes. Most patients use pre-tax dollars.
Can I drop my insurance entirely?
We don’t recommend it. Hospitalizations and surgery can hit six figures. Pair DPC with a low-cost catastrophic plan.
Can I cancel anytime?
Yes — 30 days notice.
Run Your Own Numbers
The honest answer is: it depends on your situation. But for most healthy or moderately healthy people paying their own premiums, DPC + catastrophic saves $3,000–$10,000+ per year.
Call (816) 330-7575 and we’ll walk through your specific situation — no sales pressure.