The Best Health Coverage to Pair with Direct Primary Care

ealth insurance is changing rapidly, and for many people, the costs of staying insured continue to rise each year. As we look ahead to 2026, premium increases are expected again. For many families, this means difficult decisions about how to balance cost, coverage, and access to care.

One of the simplest ways to begin thinking about a plan that works best for both your health and your wallet is by separating something we’re often taught to view as a single idea:

Coverage is not the same thing as care.

Understanding the difference and knowing how the two work together is one of the most important steps you can take to make your healthcare more affordable and more effective.

Coverage vs. Care: Why the Difference Matters

Coverage is financial protection. It is your insurance policy, something that helps protect you from a large bill if you have a major medical event, surgery, hospitalization, or expensive treatment.

Care is what keeps you healthy. It is the relationship you have with your doctor, your ability to get help when you need it, and the guidance you receive to stay healthy and prevent illness.

Frequently, when healthcare becomes extremely expensive you can point to subpar care as the root cause. Whether patients did not receive proper guidance to prevent a health issue, health problems were not caught and treated early, or if people were rushed through care or passed from specialist to specialist without properly identifying the root cause of the problem. This is where primary care makes the greatest difference in both your health and finances.

Coverage protects your wallet.
Care protects your health.

You need both, but they are not interchangeable.

Where Direct Primary Care (DPC) Fits In

In the traditional healthcare system, primary care is often rushed, transactional, and driven by insurance billing rules. This can lead to:

• Short appointments that leave little time to discuss real concerns
• Unnecessary referrals because doctors don’t have time to fully evaluate problems
• Reactive instead of proactive care
• Difficulty getting answers or access when you need help

Direct Primary Care (DPC) restores primary care to what it is meant to be: thorough, personal, and relationship-based.

Choosing Insurance When You Have DPC

Once your primary care is already handled through DPC, the role of insurance shifts. Rather than using insurance for routine care, most people now use it primarily to protect against large and unexpected medical expenses.

Below are several options people consider when pairing DPC with insurance.

1. High-Deductible Health Plans

High-deductible plans have lower monthly premiums and higher deductibles. They work well with DPC because you are less likely to use insurance for routine care, which reduces how often the deductible matters.

Best fit:

• Individuals or families who want standard insurance without the larger monthly premiums of higher tiered insurance plans
• Anyone who plans to contribute to or use a Health Savings Account (HSA)
• Those who can reasonably predict or plan their healthcare expenses (see below)

How to use alongside DPC:

• Let your DPC doctor handle most day-to-day care and early intervention
• Use insurance only when a major health event occurs or you plan to hit your deductible for the year
• Consider using HSA funds strategically to pay for your DPC membership, and even utilize the low cash pricing that we can obtain on medications and testing rather than artificially inflated insurance prices.

2. Catastrophic Plans

Catastrophic plans are designed for financial protection rather than routine care. They typically offer the lowest premiums and the highest deductibles. They also pair extremely well with Direct Primary Care for the ultimate combo of excellent care and appropriate financial protection and coverage.

While historically only available to people under 30 or those who qualified due to a financial hardship, beginning in the 2026 plan year hardship exemptions will be easier to qualify for. Specifically, if you lose health insurance subsidies, it is expected that you will be much more likely to qualify for a catastropic insurance plan. This may allow more individuals to enroll in catastrophic coverage even if they could not previously.

Best fit:

• Individuals who want insurance with the absolute lowest monthly cost while still being protected in emergencies
• People with reliable primary care who rarely need specialist or hospital-level care

How to use alongside DPC:

• Your DPC physician helps you avoid situations that might otherwise lead to higher-cost care
• If a major medical event occurs, the catastrophic plan provides financial protection

3. Health Share Organizations

Health share organizations are not insurance. Instead, members contribute to a shared pool that helps cover medical needs.

Important considerations:

• Coverage varies widely
• Some exclude pre-existing conditions or have a waiting period
• Reimbursement is not guaranteed
• Appeals processes differ from traditional insurance

Best fit:

• Individuals comfortable with community-based cost sharing
• Those looking for lower monthly costs and who value simplicity
• Patients who have stable health conditions and strong primary care support

How to use alongside DPC:

• DPC handles day-to-day care
• Health share assists when a larger medical event occurs

4. Defined Benefit / Indemnity Plans

Defined benefit plans pay a fixed dollar amount for specific medical services. For example:

• A set amount for an ER visit
• A daily amount for hospital admission
• A fixed rate for imaging or labs

These plans are straightforward and predictable, but the benefits you receive are limited to a maximum dollar amount.

Best fit:

• People who want supplemental protection but don’t want full traditional insurance
• Ideally only done with help from an experienced broker as there is a risk of incomplete coverage without expert guidance

How to use alongside DPC:

• All primary care is provided through DPC
• If hospital or specialist care is needed, patient pays the costs up front and the plan’s fixed payouts offset part of the cost

5. Medicare + DPC

For those eligible for Medicare, combining Medicare Part A (hospital coverage) with DPC for primary care is often a very effective way to get excellent care and coverage.

Best fit:

• Seniors who value time with their physician and prevention-focused care
• Must be prepared to be creative with coverage for specialist visits and medication - cost savings can still be significant even if paying out of pocket for these services

How to use alongside DPC:

• Medicare covers hospital and certain specialty needs
• DPC provides accessible, personal primary care without long wait times or rushed visits

6. Employer-Based DPC

Some employers now offer direct primary care memberships as part of their employee benefits. This can:

• Reduce employee healthcare costs
• Improve access to care
• Decrease time lost from work for appointments due to the flexible nature of care provided through a DPC physician

Employers may also pair DPC with high-deductible or catastrophic coverage to protect against major medical events.

If You Are Uninsured

While we do not recommend going without insurance long term, we recognize that many people experience periods without coverage. Direct Primary Care not only provides excellent, reliable, and continuous medical care without health insurance, but it is one of the least expensive ways to get medical care if you are uninsured.

DPC allows you to continue receiving consistent primary care and guidance, and we work to connect patients with reasonably priced lab work, imaging, medications, and referrals when needed.

Finalizing Your Healthcare Strategy

As you consider your health coverage options for 2026 and what works best for your unique healthcare needs, it can be helpful to start with the care that you desire, and then find the coverage that best fits that care. Often this will result in not only better care, but lower costs as well!