Do I Still Need Health Insurance If I Have Direct Primary Care?

A common question from people considering direct primary care is: If I join a DPC practice, do I still need health insurance?

The important distinction is that direct primary care and health insurance serve different purposes.

Direct primary care, or DPC, provides an ongoing relationship with a primary care physician through a membership model. Health insurance is designed to help cover medical expenses according to the terms of your plan, including potentially large expenses that occur outside a primary care office.

DPC is not health insurance.

Understanding that difference can help you decide how direct primary care fits into your overall healthcare plan.

What Does Direct Primary Care Cover?

Direct primary care focuses on primary care.

At Firebird Direct Primary Care in Worthington, Ohio, patients pay a membership fee rather than having the practice bill insurance for routine primary care included in the membership.

Depending on an individual patient's needs, primary care may include:

• Preventive and wellness care
• Evaluation of illnesses and new symptoms
• Chronic disease management
• Medication management
• Follow-up for conditions such as high blood pressure, diabetes, and high cholesterol
• Blood draws and selected laboratory services
• Selected office procedures
• Osteopathic evaluation and treatment when appropriate
• Coordination with specialists when additional care is needed

You can review services available at Firebird DPC.

What Doesn't a DPC Membership Cover?

A DPC membership should not be confused with comprehensive medical coverage.

Healthcare expenses outside the membership can include:

• Emergency department visits
• Hospitalization
• Surgery
• Specialist care outside the practice
• Advanced imaging
• Outside laboratory testing
• Prescription medications obtained outside the practice
• Other services provided by outside healthcare organizations

Those expenses remain separate from your Firebird DPC membership.

Why Would Someone Have Both DPC and Health Insurance?

The two can serve different roles.

A DPC membership can provide ongoing access to primary care while an insurance plan may provide financial protection for larger medical expenses covered under that plan.

For example, a patient might use Firebird DPC for routine primary care, preventive care, chronic disease management, and evaluation of new symptoms.

If that patient later requires hospitalization, surgery, advanced imaging, or specialty treatment, those services take place outside the DPC membership.

That is why having DPC does not eliminate the need to think about how you would pay for major medical expenses.

Can DPC Be Used With a High-Deductible Health Plan?

Patients with many different types of insurance arrangements may choose direct primary care.

Some people are particularly interested in DPC because they have a high deductible and want a predictable way to access primary care.

However, insurance rules and individual circumstances can vary. Patients should review the terms of their own health plan and, when necessary, discuss questions about coverage or eligibility with their insurer, benefits administrator, tax professional, or other appropriate adviser.

What If I Don't Have Health Insurance?

Health insurance is not required to become a Firebird DPC member.

An uninsured patient can still establish an ongoing primary care relationship through the practice.

However, being a DPC member does not provide insurance coverage for medical expenses outside the membership.

Someone without insurance should therefore consider how they would handle expenses such as an emergency department visit, hospitalization, surgery, imaging, or specialist care.

For more information, read Can You See a Primary Care Doctor Without Insurance in Columbus, Ohio?.

You can also learn more about primary care without insurance in Columbus.

Does DPC Make Health Insurance Unnecessary?

There isn't one answer that applies to every patient.

A person's decision about insurance depends on factors beyond primary care, including finances, family circumstances, medical needs, risk tolerance, available insurance options, and potential exposure to large healthcare expenses.

What DPC changes is how primary care is delivered and paid for.

It does not turn the primary care membership into coverage for the rest of the healthcare system.

How Much Does Direct Primary Care Cost?

DPC practices generally use predictable membership pricing.

Instead of receiving a separate insurance bill for each routine primary care visit included in the membership, patients pay the practice directly according to its membership structure.

We explain this in more detail in How Much Does Direct Primary Care Cost in Columbus, Ohio?.

Current Firebird DPC rates are available on our Membership page.

How Should I Think About DPC and Insurance?

It can help to think of them as answering two different questions.

Direct primary care:
How do I want to receive my everyday and ongoing primary care?

Health insurance:
How will I handle medical expenses covered by my plan, particularly potentially expensive care outside the primary care office?

Those questions overlap, but they are not the same.

Understanding both can help you make a more informed decision about your healthcare.

Learn More About Direct Primary Care in Worthington, Ohio

Firebird Direct Primary Care provides membership-based family medicine from our office in Worthington, serving patients from Worthington, Columbus, and surrounding Central Ohio communities.

If you're trying to determine how DPC might fit with your current healthcare coverage, start with our guide to how direct primary care works and review our membership options.

You can also schedule a free 15-minute Meet & Greet with Dr. Mark Hagen to learn about the practice before deciding whether to join.

Firebird Direct Primary Care
7100 N. High Street, Suite 202
Worthington, Ohio 43085