What Is Direct Primary Care? A Guide for Employers and Schools
Employers and school leaders searching for direct primary care (DPC) want clearer access to routine care without turning every primary care visit into another insurance claim. Here is what DPC is, how it differs from insurance and concierge care, what changed for HSAs in 2026, and how to reach us.
8 min read
Short answer: A plain-English guide to direct primary care for employers and schools: what DPC is, how it differs from insurance and concierge care, 2026 HSA rules, and how to reach us in TX, CA, SC, and East Tennessee.
Talk to us about direct primary care
Interested in DPC for a school or business in Texas, California, South Carolina, or East Tennessee? Send a short note and we will follow up. This is separate from SIMRP plan questions.
Prefer to pick a time? Schedule a DPC call.
Or email [email protected] with subject "Direct primary care inquiry".
Educational only, not tax advice. This article explains what direct primary care is and general tax guidance that applies to DPC itself. It is not tax, legal, or benefits advice, and it is not an endorsement of any clinic network.
What employers and schools mean by "direct primary care"
Direct primary care is a membership model for routine primary care. The American Academy of Family Physicians describes DPC as a practice and payment approach built around a flat recurring fee rather than insurance billing for those primary care visits.
For employers and schools, that usually means paying a per-employee (or per-member) fee so workers and often dependents can see primary care for everyday needs with little or no visit copay inside the membership. DPC is not insurance. Hospitals, specialists, surgery, emergencies, and many other costs still need separate major medical or other qualifying coverage.
That distinction matters: DPC can improve access to everyday care, but it does not by itself replace the role of health coverage.
DPC vs. traditional insurance
- Insurance spreads risk for a wide range of medical costs, usually with premiums, deductibles, and networks.
- DPC buys access to primary care through a membership fee. It is care access, not a substitute for major medical.
Organizations that explore DPC usually keep major medical (or other qualifying coverage) in place and look at DPC as a way to make routine primary care easier to use.
DPC vs. concierge medicine
Decision-makers often compare DPC with concierge medicine. This short table is educational and does not name or rank clinics.
| Topic | Direct primary care (typical) | Concierge medicine (typical) |
|---|---|---|
| Fee style | Flat periodic membership for primary care | Often a higher retainer paid to the practice |
| Insurance billing for those visits | Usually does not bill insurance for included primary care visits | May still bill insurance for some services, depending on the practice |
| Fee level (qualitative) | Often positioned as an accessible monthly membership; confirm locally | Often higher-touch and higher cost; confirm locally |
| Who it often serves | Individuals, families, and employer- or school-sponsored memberships seeking everyday primary care access | Patients seeking a smaller panel / higher-touch relationship |
Educational comparison aligned with how the AAFP discusses DPC versus concierge models. Exact designs vary by practice.
How schools may benefit
Schools often care about staff being able to get a primary care appointment when they need one, without missing more work than necessary or navigating confusing bills for simple visits the membership includes. A known membership fee can make that primary-care piece easier to budget than only discovering access problems after the fact.
How businesses may benefit
Businesses, especially smaller employers, often want the same clarity: predictable cost for included primary care, a named care relationship, and fewer barriers to everyday visits. Fit still depends on local availability and what any given membership covers.
Exploring DPC in Texas, California, South Carolina, and East Tennessee
We help schools and businesses in Texas, California, South Carolina, and East Tennessee (Knoxville, Chattanooga, and the Tri-Cities) explore these questions. For city-level market notes and the primary inquiry form, see Direct Primary Care for Schools and Businesses.
DPC and HSAs in 2026
IRS Notice 2026-05 (summarized in the IRS newsroom release) explains that for months beginning after December 31, 2025:
- Certain qualifying direct primary care service arrangements are not treated as a disqualifying health plan for HSA eligibility when monthly fees stay within the caps ($150 individual / $300 if the arrangement covers more than one person for 2026).
- HSA funds may pay qualifying fixed periodic DPC fees.
- Q-18: employer-paid DPC fees (including Section 125 salary reduction) are not also reimbursable from an HSA.
Earlier IRS IR-2020-116 / proposed regulations (85 FR 35398) discussed DPC fees as Section 213(d) medical care for itemized deduction / HRA discussion purposes, but those 2020 rules remain proposed. Use Notice 2026-05 for current HSA questions about qualifying DPC arrangements, and confirm details with a tax advisor.
Questions to ask a DPC practice or network
Bring this checklist to any conversation. We do not name clinic networks on this page.
- What is included in the membership fee, and what is billed separately?
- How are new-patient wait times and same-day needs handled?
- Are messaging and virtual visits included?
- Which locations would our employees use?
- How are dependents covered?
- How does the practice coordinate specialty or hospital care?
- How does this interact with Health Savings Accounts under the 2026 rules?
- What happens when an employee leaves mid-year?
- Can we review a sample agreement and exclusions list first?
Frequently asked questions
What is direct primary care for employers?
Employer-sponsored DPC usually means the employer pays all or part of a flat membership fee so employees (and often dependents) can use routine primary care without insurance billing for those visits. DPC is not insurance and is typically kept alongside separate major medical or other qualifying coverage.
Is DPC useful for schools as well as businesses?
Yes. School leaders often evaluate DPC for clearer access to everyday care for staff, a more predictable membership cost for included primary care, and fewer barriers to getting a primary care visit when someone is sick.
Is DPC good for small businesses?
Many small employers look at DPC because the cost is a predictable membership fee rather than claim-driven primary care spend for included visits. Whether it fits depends on local DPC availability, what the membership covers, and how it sits beside existing coverage and tax accounts such as HSAs.
How is DPC different from concierge medicine?
DPC usually uses a flat periodic fee for primary care without insurance billing for those visits. Concierge care often involves a higher retainer and may still bill insurance for some services. Designs vary; compare fee style, billing, access, and what is included.
Do employees still need insurance with DPC?
Yes in almost every case. DPC does not replace major medical coverage for hospitals, specialists, surgery, or emergencies.
How do the 2026 HSA rules affect DPC?
Under IRS Notice 2026-05, for months beginning after December 31, 2025, certain qualifying direct primary care service arrangements within the monthly fee caps generally do not disqualify HSA eligibility, and HSA funds may pay qualifying fees. Employer-paid fees are not also reimbursable from an HSA (Q-18). This is educational only, not tax advice.
Who should I contact if my organization is exploring DPC?
If you are a school or business in Texas, California, South Carolina, or East Tennessee, use the direct primary care inquiry form on this page or on the schools-and-businesses overview. You can also schedule a DPC call or email [email protected] with subject Direct primary care inquiry.
Sources
Educational only, not tax advice. This article explains what direct primary care is and general tax guidance that applies to DPC itself. It is not tax, legal, or benefits advice, and it is not an endorsement of any clinic network.
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Talk to us about direct primary care
Interested in DPC for a school or business in Texas, California, South Carolina, or East Tennessee? Send a short note and we will follow up. This is separate from SIMRP plan questions.
Prefer to pick a time? Schedule a DPC call.
Or email [email protected] with subject "Direct primary care inquiry".
Written by Jake Parvu
Jake Parvu is a licensed financial agent and benefits educator with SIMRP Health & Wellness™. Licensed since 2007, his background includes serving Florida public school employees and working as a Certified Federal Retirement Consultant. He now educates public schools and private businesses on the proper use and administration of IRS Code Compliant Self-Insured Medical Reimbursement Plans.