Learn How Direct Primary Care Works as an HSA-Qualified Medical Expense
Every year, health insurance open enrollment gives you the chance to review your coverage and choose a plan that fits your needs. Whether you’re buying individual health insurance for the first time or thinking about switching plans, this period is your opportunity to make changes that will affect your healthcare costs and access for the year ahead.
But insurance is only one part of a complete healthcare strategy. Many people are also turning to direct primary care (DPC) providers to improve access to everyday medical care. When combined with the right insurance plan, DPC can help you save money, reduce stress, and get more personalized care.
Below is a guide to understanding your insurance options and how direct primary care fits into your overall healthcare planning.
What Is Open Enrollment for Health Insurance?
Open enrollment for health insurance is the annual window when you can enroll in, renew, or change your health plan. For most people, this happens once a year unless you qualify for a special enrollment period due to major life changes like marriage, job loss, or having a baby.
During this time, you can compare plans, check your subsidy eligibility, and choose coverage that matches your medical needs and budget. Because you’re locked into your plan for the year unless you have a qualifying event, it’s important to take this period seriously and make informed decisions.
Understanding Individual Health Insurance Options
Individual health insurance is available through the federal marketplace, private insurers, and licensed brokers. Before choosing a plan, it helps to understand key terms like premiums, deductibles, copays, coinsurance, and out‑of‑pocket maximums. These costs determine how much you’ll pay each month and how much you’ll pay when you receive care.
When comparing individual health insurance options during open enrollment, you’ll find several types of plans, each offering different levels of cost, flexibility, and coverage.
Marketplace Plans (Bronze, Silver, Gold, Platinum)
These plans follow Affordable Care Act (ACA) rules and offer different levels of cost‑sharing. Bronze plans have lower premiums but higher out‑of‑pocket costs, while Gold and Platinum plans cost more each month but cover more of your care.
High‑Deductible Health Plans (HDHPs)
HDHPs pair with Health Savings Accounts (HSAs), which allow you to set aside tax‑free money for HSA-qualified medical expenses. These plans often work well for people who want lower premiums and are comfortable with higher deductibles.
PPO, HMO, and EPO Plans
These plans differ in how they handle networks and referrals. PPOs offer the most flexibility, while HMOs and EPOs typically require you to stay in network.
Short‑Term or Catastrophic Plans
These plans offer limited coverage and are best for healthy individuals who want protection from major medical events. They are not a replacement for full ACA‑compliant insurance.
Healthcare Sharing Plan
A healthcare sharing plan, also called a health care sharing ministry (HCSM), is a membership‑based program where individuals voluntarily contribute funds to help pay for one another’s medical expenses. Instead of traditional insurance, members share costs as a community, following the organization’s guidelines and values.
How Direct Primary Care Fits Into Your Healthcare Strategy
Direct primary care is a membership‑based model where you pay a monthly fee for unlimited access to your primary care provider. DPC providers offer longer appointments, same‑day or next‑day visits, and direct communication with your doctor.
DPC memberships are not the same thing as insurance; however, they work in tandem with individual health insurance to create a more complete healthcare experience. Here are the main benefits of combining DPC with insurance:
- You get predictable, affordable access to everyday care.
- You can choose a lower‑premium insurance plan because your primary care needs are covered through DPC.
- You avoid long wait times and rushed appointments.
- You reduce the need for urgent care or emergency room visits for non‑emergencies.
For many people, pairing a DPC plan with an HDHP is a cost‑effective strategy. You use your insurance for major medical events and your DPC membership for routine care.
Choosing the Right Insurance Plan When You Use Direct Primary Care
If you already have a DPC membership or are considering one, here are things to keep in mind during open enrollment for health insurance:
- You may not need a plan with high primary care copays or expensive office visit coverage.
- HDHPs can be a good match because they offer lower premiums and allow you to save money tax‑free for HSA-qualified medical expenses.
- Make sure your plan still covers hospitalizations, specialist visits, and emergency care.
- Review prescription coverage if you take regular medications.
- As of January 1, 2026, DPC memberships qualify as an HSA-eligible expense.
The goal is to avoid paying twice for the same type of care. DPC covers your everyday needs, while insurance protects you from major expenses.
Cost Considerations: Insurance vs. Out‑of‑Pocket Care
When choosing a plan, think about your total yearly healthcare costs — not just your monthly premium. Consider:
- How often you visit the doctor.
- Whether you need regular lab work or medications.
- Your comfort level with deductibles.
- Whether a DPC membership reduces your need for traditional office visits.
DPC can help you avoid unexpected bills and make your healthcare spending more predictable.
Pair Your Individual Health Insurance With a DPC Membership
Choosing the right individual health insurance plan during health insurance open enrollment is one of the most important decisions you make each year. By understanding your options and considering how direct primary care fits into your overall plan, you can create a healthcare strategy that supports your health and your budget.
Direct primary care providers offer a level of access and personal attention that traditional insurance alone can’t match. When combined with the right insurance plan, you get the best of both worlds: everyday care you can count on and financial protection for major medical needs.
