Concierge Medicine vs. Direct Primary Care (DPC)

If you are exploring alternatives to traditional primary care, you have likely encountered two terms: concierge medicine and direct primary care (DPC). While both models share the philosophy of smaller panel sizes and better physician access, they differ in meaningful ways — especially around insurance, pricing, and the scope of services included. This guide breaks down each model so you can determine which is the right fit.

The Core Difference

Concierge medicine charges a membership fee for enhanced access and typically still bills your health insurance for office visits and medical services. Direct primary care (DPC) charges a membership fee that covers most or all primary care services. DPC practices generally do not bill insurance at all.

In short: concierge medicine is an access layer on top of insurance; DPC is a replacement for insurance-based primary care billing.

How Concierge Medicine Works

In a concierge practice, you pay a retainer fee (typically $200-$500/month) for enhanced access to your physician. This buys you:

• Same-day or next-day appointments
• Longer visits (30-60 minutes)
• Direct phone, text, or email access to your doctor
• Comprehensive annual wellness exams
• Care coordination with specialists

Your health insurance continues to play its normal role. The concierge practice submits claims to your insurance for office visits, labs, procedures, and other covered services. You still pay copays and meet your deductible. The membership fee is an additional cost that covers the "concierge" experience — better access, more time, and a smaller patient panel. Typical panel size: 300-600 patients per physician Typical fee: $200-$500 per month ($2,400-$6,000 per year) Insurance billing: Yes — practice bills insurance for covered services

How Direct Primary Care Works

In a DPC practice, you pay a monthly membership fee (typically $50-$150/month) that covers most primary care services directly. There is no insurance billing for primary care visits.

Your DPC membership typically includes:

• Unlimited office visits
• Basic lab work (CBC, metabolic panels, lipid panels, A1C, etc.)
• Simple in-office procedures (suturing, joint injections, skin biopsies)
• Telemedicine visits
• Direct physician communication
• Preventive care and wellness planning
• Sometimes: discounted imaging and specialty referrals through the practice's network

DPC practices avoid insurance billing entirely for primary care. This eliminates the administrative overhead of coding, billing, pre-authorizations, and insurance negotiations. The savings from reduced administrative costs allow DPC physicians to charge lower membership fees while still maintaining small panel sizes. Typical panel size: 400-800 patients per physician Typical fee: $50-$150 per month ($600-$1,800 per year) Insurance billing: No — membership covers primary care services

Side-by-Side Comparison

Insurance Implications

With Concierge Medicine

You keep your full health insurance plan and use it as you normally would. The concierge fee is simply an additional cost for better access. Your insurance covers:

• Office visit charges (after copay)
• Labs and imaging
• Specialist referrals
• Hospitalizations
• Emergency care
• Prescriptions

Do you still need insurance? Absolutely. The concierge membership does not replace any insurance coverage.

With Direct Primary Care

Because DPC does not bill insurance for primary care, your insurance is essentially unused for routine doctor visits. However, you still need insurance for:

• Specialist visits
• Hospitalizations
• Emergency care
• Advanced imaging (MRI, CT)
• Prescriptions (unless your DPC offers wholesale pricing)
• Anything beyond primary care scope

Many DPC patients pair their membership with a high-deductible health plan (HDHP), which has lower premiums since they are not using insurance for primary care. This combination — low-premium catastrophic coverage plus DPC membership — can sometimes cost less in total than a traditional PPO plan with copays. Do you still need insurance? Yes, for everything beyond primary care. But you may be able to choose a cheaper, high-deductible plan.

Which Model Is Right for You?

Choose Concierge Medicine If:

• You want the most exclusive level of access. Concierge practices tend to have smaller panels and offer more premium services (executive physicals, house calls, travel medicine).
• You have a preferred PPO/HMO plan that you want to continue using for all services, including primary care.
• You have complex medical needs and want a physician who will spend 45-60 minutes per visit and actively coordinate your specialist care.
• Budget is less of a concern and you are willing to pay more for a higher-touch experience.
• You are a senior on Medicare and want a physician who still bills Medicare for covered services while providing enhanced access.

Choose Direct Primary Care If:

• Cost efficiency is important. DPC memberships are significantly cheaper, and the all-inclusive nature (visits + labs + procedures) can save money compared to copay-based care.
• You are healthy or have straightforward medical needs and want a good primary care relationship without the premium price tag.
• You are self-employed or buying your own insurance and want to pair DPC with a high-deductible plan to minimize total healthcare spending.
• You are frustrated with insurance bureaucracy and want a practice that has zero involvement with insurance paperwork, pre-authorizations, and billing disputes.
• You are a young professional or family looking for affordable, high-quality primary care.

Hybrid Models

Some practices operate as hybrids, combining elements of both models. A hybrid practice might:

• Charge a moderate membership fee ($150-$300/month)
• Include basic labs and simple procedures in the membership
• Bill insurance for office visits and more complex services
• Maintain a moderate panel size (400-600 patients)

Hybrid models attempt to offer the best of both worlds: the inclusive service scope of DPC with the insurance compatibility of concierge medicine. They are a growing segment of the market.

Common Misconceptions

"Concierge medicine is only for the rich."

While premium concierge practices can be expensive, mid-range options ($200-$300/month) are increasingly accessible to middle-class families, especially when the value of avoided ER visits, less time off work, and better chronic disease management is factored in.

"DPC means I don't need health insurance."

This is false and dangerous. DPC covers primary care only. A single ER visit, hospitalization, or specialist procedure can cost tens of thousands of dollars. You need catastrophic or comprehensive insurance alongside DPC.

"Both models are unregulated."

Both concierge medicine and DPC are legal and practiced by licensed physicians. DPC is specifically recognized in the legislation of over 35 states, with laws clarifying that DPC agreements are not insurance products. Both models are subject to the same medical licensing, malpractice, and practice standards as traditional medicine.

"The quality of care is the same — you're just paying for convenience."

Research suggests otherwise. Studies have shown that patients in concierge and DPC practices have fewer hospitalizations, fewer ER visits, and better management of chronic conditions. The extended appointment times and continuity of care lead to earlier diagnosis and more effective treatment.

Frequently Asked Questions

Can I switch from concierge to DPC (or vice versa)?

Yes. There is no lock-in between the two models. If you find that one model suits your needs better, you can change practices. Be mindful of any contractual obligations (some concierge practices have annual agreements) and ensure continuity of care by transferring your medical records.

Do either of these models cover specialist visits?

No. Neither concierge nor DPC memberships cover specialist visits. However, both models emphasize care coordination — your primary care physician will help you find the right specialist, manage referrals, and follow up on specialist recommendations. Specialist visits are billed to your insurance.

Which model has better outcomes?

Both models show improved outcomes compared to traditional primary care, likely because of smaller panels, longer appointments, and stronger patient-physician relationships. Head-to-head research comparing concierge vs. DPC outcomes is limited, but the underlying mechanism (more physician time per patient) is similar in both.

Can families enroll in either model?

Yes. Both concierge and DPC practices commonly offer family memberships, often at a discounted per-person rate. Some practices specialize in family medicine and include pediatric care.

What if my employer offers a concierge benefit?

A growing number of employers are offering concierge or DPC memberships as an employee benefit, either as a standalone offering or bundled with their health plan. If your employer provides this benefit, it can significantly offset the cost. Ask your HR department whether executive health or concierge primary care benefits are available.