Insights / For families
Direct Primary Care vs Health Insurance: How They Actually Compare
They do different jobs, and most people who are happy with either end up using both. A straight comparison, including the case for insurance.
This is the question we get asked more than any other, and it is usually asked as if it were a choice between two things. It mostly is not. Direct primary care and insurance do different jobs, and the useful question is which combination fits your household.
Here is the honest comparison.
They are not the same kind of thing
Insurance is a contract that pays toward large, unpredictable medical costs. You pay a monthly amount, you have a deductible you must reach before most things are paid for, and in exchange you have a legal claim on the insurer when something serious happens.
Direct primary care is a subscription to a doctor. You pay the practice a flat monthly fee and you get access to primary care without a bill each time. There is no deductible because there is nothing to claim against. There is also nobody obliged to pay for your surgery.
One handles the everyday layer. The other handles the catastrophe. They are not substitutes and anyone presenting them as substitutes is either confused or selling.
Side by side
| Direct primary care | Health insurance | |
|---|---|---|
| What it is | A subscription to a practice | A contract to pay toward claims |
| Monthly cost | Flat, typically $50 to $175 per adult | Varies; Montana 2026 averages about $750 full price, about $107 after the average tax credit |
| Deductible | None | Usually thousands before most things are paid |
| Everyday visits | Included, no charge at the visit | Often paid out of pocket until the deductible is met |
| Visit length | Typically 30 to 60 minutes | Typically 7 to 15 minutes |
| Reaching your doctor | Phone, text or email, directly | Through the office, usually |
| Hospital and surgery | Not covered | Covered, contractually |
| Specialists | Not covered, though referrals are made | Covered in network |
| Legal obligation to pay | None | Yes |
Why people pair them
The most common arrangement in practice is a direct primary care membership alongside something that handles large bills, usually a high-deductible plan.
The logic is straightforward. Most households use primary care many times a year and a hospital almost never. A high-deductible plan is cheap precisely because you rarely reach the deductible, which is also the reason it does nothing for the care you actually use. Putting a membership underneath it covers the frequent layer at a fixed price, so the deductible stops being the thing that decides whether you go to the doctor.
Two things changed in 2026 that made this pairing easier:
- HSA money can now pay direct primary care membership fees, up to $150 a month for an individual and $300 for a family
- Joining a direct primary care practice no longer disqualifies you from contributing to an HSA
We covered both in Your HSA Just Changed.
The case for insurance, made properly
We are a membership company and we will still say this clearly.
If you qualify for a meaningful marketplace subsidy, insurance is extremely hard to beat. About eight out of ten Montana marketplace enrollees do qualify, and the average subsidised enrollee pays around $107 a month for something with a legal obligation behind it. That is a good deal by any measure.
Insurance also does something no membership can: it caps your worst case. A maximum out-of-pocket is a real number that a company is contractually bound to honour. Cost-sharing arrangements, including the one CoreMed uses, are not the same thing and are not guaranteed.
If you have a serious ongoing condition, if you use specialists regularly, or if a large bill would be financially catastrophic, that contractual protection is worth paying for.
The case for direct primary care, made properly
Where the membership model earns its place is the everyday layer, which is where the actual medicine mostly happens.
Research published in January 2026 in the Journal of the American Board of Family Medicine looked at Medicare records from more than a million patients across nearly 5,000 practices. Patients whose doctors had the most consistent ongoing relationships had roughly 7 to 10% lower total healthcare spending, about 5 to 9% lower odds of hospitalisation the following year, and about 5 to 6% lower odds of an emergency room visit.
That is an association rather than proof of cause, and it was a Medicare population. But it lines up with what the model is built to produce: smaller panels, longer visits, and a doctor who notices when something has changed. We wrote about it in A Doctor Who Knows You.
The other honest argument is behavioural. A deductible is a toll booth in front of your own doctor. People with high deductibles put things off, and things that get put off get more expensive.
How to decide
- Check your subsidy first. If you qualify for a large tax credit, start there. It changes the whole calculation.
- Count what you actually used last year. Primary care visits, labs, prescriptions. Not what you feared using.
- Find your deductible and ask honestly whether you reached it. If you never get near it, you are paying for protection you use once a decade and paying cash for everything else.
- Price the pairing, not just the pieces. A high-deductible plan plus a membership is one number, and it is the number to compare.
- Ask what happens in the bad scenario. For anything that is not insurance, ask specifically whether payment is guaranteed. If the answer is no, decide whether you can live with that.
Where CoreMed sits
We build memberships on direct primary care across Eureka, the Flathead Valley, Helena, Bozeman and Billings, and pair them with cost sharing through Zion HealthShare for large bills.
CoreMed membership is not insurance. Cost sharing is not guaranteed payment. We put that in writing on every page because the distinction is the most important thing a person shopping in this category needs to understand.
Price it against your alternatives on the quote calculator, or email info@coremedhealth.com and we will talk it through, including when the answer is that a marketplace plan suits you better.
This article is general information, not medical or financial advice. Montana marketplace figures are for 2026 and reset annually.
