How to Switch to a Direct Primary Care Practice: A Step-by-Step Patient Guide

In a traditional primary care office, your doctor bills your insurance company for each visit. The practice earns revenue per service, which pushes doctors to see more patients per day. The American Academy of Family Physicians (AAFP) notes that direct primary care practices instead charge patients a flat monthly or annual membership fee in exchange for a defined set of primary care services. That fee goes directly to the practice, with no insurance billing for covered services.

Because DPC practices do not bill insurance for primary care visits, they typically carry smaller patient panels, which means your doctor has more time per appointment. Visits can happen in person, by phone, or by video. Some practices include basic labs, generic medications, or minor procedures in the membership fee, though what is included varies widely by practice. You should always ask a specific practice exactly what its membership covers before you sign up.

One critical point: a DPC membership is not health insurance. It does not cover hospitalizations, emergency care, specialist visits, surgery, or prescription drugs outside what the practice explicitly includes. The Centers for Medicare and Medicaid Services (CMS) and the IRS both treat DPC memberships as a separate category from insurance coverage. Most patients pair a DPC membership with a high-deductible health plan, a health-sharing ministry, or another form of coverage for serious or unexpected medical events.

Before you leave your current practice, get a complete copy of your medical records. Under the Health Insurance Portability and Accountability Act (HIPAA), you have the right to access and receive a copy of your health information. The U.S. Department of Health and Human Services (HHS) explains that providers must give you access to your records, generally within 30 days of your request, and they can charge only a reasonable, cost-based fee for copies. You can find guidance on your rights at HHS.gov.

Ask your current practice for a summary that includes your problem list, current medications and dosages, allergy list, immunization history, recent lab results, and any specialist notes. A printed or electronic copy works. Many practices can send records directly to your new DPC physician if you sign a release form. Bring a copy to your first DPC appointment even if the records were sent ahead, so nothing falls through the cracks.

If you have ongoing prescriptions, ask your current doctor for a 30- to 90-day supply or a bridge prescription to cover the gap while your new DPC physician reviews your history. Do not stop any medication without talking to a licensed clinician first. Your new DPC doctor will review your full record and discuss any changes at your first visit.

Every DPC practice has a membership agreement, sometimes called an enrollment contract or direct care agreement. Read it carefully before you pay anything. The agreement should spell out the monthly or annual fee, what services are included, what costs extra, how to cancel, and how much notice you must give to end the membership. The AAFP recommends that patients ask practices to explain any terms that are unclear.

Pay attention to cancellation and refund policies. Some practices bill month to month with a 30-day cancellation window. Others require a longer commitment or charge an enrollment fee. Ask whether the practice has a patient limit and what happens if the physician leaves or retires. Understanding these details upfront protects you from unexpected charges later.

Also ask about after-hours access. One of the most cited benefits of DPC is the ability to reach your doctor outside normal office hours by phone or text. But the specifics vary. Some practices offer 24/7 direct physician access; others have defined hours with an on-call arrangement. Get the details in writing so your expectations match what the practice actually provides.

Because DPC is not insurance, you still need a plan for hospitalizations, emergency room visits, specialist care, and major procedures. Many DPC patients pair their membership with a high-deductible health plan (HDHP). Under IRS rules, if you want to contribute to a Health Savings Account (HSA) alongside an HDHP, the DPC membership must meet specific IRS criteria. The IRS has issued guidance on this topic, and the rules have evolved over time. Check IRS.gov or speak with a tax professional to confirm current eligibility rules before assuming your DPC membership is HSA-compatible.

If you buy insurance through the Health Insurance Marketplace, you can still enroll in a DPC practice. HealthCare.gov notes that marketplace plans cover essential health benefits, including primary care, but a DPC membership is a separate arrangement. Some patients choose a lower-premium, higher-deductible marketplace plan and use the DPC membership for routine primary care, reserving the insurance for larger medical events. Others who qualify for Medicaid or Medicare may face additional rules about how DPC memberships interact with those programs. CMS has published guidance on DPC arrangements for Medicare patients, so check Medicare.gov for current information if you are 65 or older.

Health-sharing ministries are another option some DPC patients use instead of traditional insurance. These are not insurance products and are not regulated the same way. They carry their own risks and limitations. Research any health-sharing arrangement carefully and understand what it will and will not cover before relying on it as your only safety net alongside a DPC membership.

Your first appointment with a DPC physician is typically longer than a standard office visit at a traditional practice. Use that time well. Bring your full medication list, your transferred records, your insurance or coverage information, and a written list of your health concerns and goals. Be honest about your medical history, including conditions you may not have mentioned to previous doctors.

Talk openly about how you prefer to communicate. Ask whether the practice uses a patient portal, secure messaging, phone calls, or video visits for routine questions. Ask how urgent concerns are handled between scheduled appointments. Understanding the communication workflow helps you get the most out of your membership from day one.

Ask your new physician how specialist referrals work. DPC practices do not typically have in-house specialists, so your doctor will refer you to outside providers when needed. Some DPC practices have negotiated cash-pay rates with local specialists or imaging centers, which can lower your out-of-pocket costs. Ask whether the practice has those arrangements and how they work before you need a referral.

One of the most common mistakes is canceling your current insurance or primary care relationship before your DPC membership is fully active and your records have been transferred. Leave a gap and you may find yourself without coverage or access to your medical history at a critical moment. Overlap your coverage by at least a few weeks to make sure the transition is smooth.

Another mistake is assuming all DPC practices offer the same services. The DPC model is flexible, and practices differ significantly in what they include, how they price memberships, and what patient populations they serve. A practice focused on pediatric care looks very different from one focused on adults with chronic conditions. Use a directory to compare practices in your area and ask specific questions before committing.

Finally, do not skip the conversation about chronic conditions or ongoing medications. If you manage a condition that requires regular monitoring, lab work, or specialist coordination, make sure your new DPC physician has the full picture before your first visit. Bring documentation, not just a verbal summary. A complete handoff protects your health and helps your new doctor serve you well from the start.

DirectMedicine is a free directory of direct-pay, cash-pay, and direct primary care practices across the United States. When you are ready to find a DPC practice, you can use DirectMedicine to browse providers in your area, compare the services each practice lists, and review pricing information that practices have chosen to share publicly. Transparent pricing is a core value of the DPC model, and DirectMedicine makes it easier to find practices that publish their membership fees upfront.

The directory is designed for patients who want to make informed decisions without having to call a dozen offices just to get basic information. You can filter by location, practice type, and other criteria to narrow your options before you reach out to a specific practice. From there, you can contact the practice directly to ask the detailed questions this guide covers, such as what the membership includes, how cancellation works, and whether the practice has cash-pay specialist arrangements.

DirectMedicine does not endorse specific providers or make claims about outcomes. It connects patients with practices that have chosen to be transparent about their care model and pricing. That transparency is the starting point for a better primary care relationship, and this guide gives you the questions to ask once you find a practice worth considering.