The Quick Answer: Direct Primary Care (DPC) is a flat monthly membership that gives employees unlimited access to a primary care doctor, no copays and no insurance billing for routine care. More than 7,200 employers now offer it as a benefit, and employer groups with DPC spend roughly 52% less on healthcare than comparable non-DPC groups [3].
Important: Direct Primary Care is a membership arrangement with a doctor for primary care services. It is not insurance and doesn't meet ACA minimum coverage requirements on its own. Health sharing plans are not insurance. Sharing of medical costs among members is voluntary and is not guaranteed the way payment is under an insurance contract.
Health sharing programs are not available in every state. The program we most often recommend is not currently accepting new members in California, New Mexico, Pennsylvania, Vermont, or Washington. Ask an advisor about options where you live.
Because most employer health plans renew on a January 1 plan year, August and September are exactly when this decision gets made, before open enrollment opens on November 1, 2026 [5][6].
If your renewal packet just landed, or is about to, you already know the pattern. Average family premiums for employer-sponsored coverage climbed to $26,993 this year, up 6% from 2025, and single coverage now averages $9,325 [1]. In 2025, family premiums rose faster than both workers’ wages and inflation [1]. Every fall, the same conversation happens: absorb the increase, shift more of it to employees, or cut something from the plan.
There is a fourth option that more employers are quietly adding to that list: layering Direct Primary Care underneath whatever medical plan you already offer.
Why This Is a Renewal-Season Decision, Not a January Decision
Most employers with a calendar-year plan hold their own open enrollment in October or November, ahead of the ACA Marketplace’s public open enrollment window, which runs November 1, 2026 through January 15, 2027 for 2027 coverage, with December 15 as the deadline for a January 1 start [5][6]. That means whatever changes you are making to your benefits lineup for 2027 need to be decided, priced, and communicated well before your open enrollment meetings start.
DPC is not something you can bolt onto a plan two weeks before enrollment. Contracting with a local practice or a national DPC network, setting up payroll deductions or a direct employer contribution, and writing enrollment materials that explain a benefit most employees have never heard of all take lead time. August is early enough to do this properly. October is not.
What Direct Primary Care Actually Is, in Employer Terms
Direct Primary Care is a membership model where a primary care physician is paid a flat monthly fee per employee, rather than billing insurance per visit. In exchange, employees get:
- Unlimited primary care visits, with no copay
- Same-day or next-day appointments, typically 30 to 60 minutes long instead of the 7 to 10 minutes typical in a traditional practice [7]
- Direct text, call, or telehealth access to their doctor
- Chronic condition management, preventive care, and often wholesale-priced labs and prescriptions
For an employer, DPC is usually layered underneath a separate plan for catastrophic coverage, such as a group HDHP, a CHOICE Arrangement (Custom Health Option and Individual Care Expense Arrangement, formerly ICHRA), or a health sharing arrangement, not offered as a standalone replacement for major medical coverage.
The Numbers Employers Are Looking At
DPC has moved from a niche idea to a mainstream benefits conversation over the past few years. Some of the data driving that shift:
| Metric | Figure |
|---|---|
| Employers currently offering DPC | 7,200+ [3] |
| Share of all DPC memberships that are employer-sponsored | 60% [4] |
| Healthcare spend reduction for employer DPC groups vs. non-DPC groups | ~52% [3] |
| Employer retention of DPC after year one | 85% [4] |
| Employer retention at the two-year mark | 70% [4] |
| Reduction in ER visits associated with DPC access | Up to 40% [4] |
| Reduction in hospitalizations associated with DPC access | Up to 30% [4] |
The retention numbers matter as much as the cost numbers. A benefit that 85% of employers keep after the first year is not a fad; it is something employers are seeing work in practice, not just on paper.
What DPC Solves for an Employer Specifically
Cost predictability. Group health plan renewals can swing from year to year based on your group’s claims history. A DPC membership fee, by contrast, is flat and known in advance. It does not eliminate the need for a catastrophic coverage layer, but it removes a meaningful, volatile chunk of your healthcare spend from the unpredictable side of the ledger.
Retention and recruiting. In a job market where health benefits are one of the first things a candidate compares between offers, being able to say employees get same-day access to a doctor who actually knows them, with no copay, is a differentiated pitch, especially against employers who only offer a high-deductible plan with no primary care layer underneath it.
Fewer downstream costs. Employer groups using DPC have reported fewer ER visits and hospitalizations [4]. Those are the costs that weigh most heavily on a group health plan’s claims experience and next year’s renewal number.
A lighter lift than a full plan change. Adding DPC does not require replacing your current medical plan. It can be layered on top of a group HDHP, a CHOICE Arrangement, or, for smaller employers exploring alternatives to traditional group coverage, a health sharing arrangement.
Three Ways Employers Are Structuring It
- Fully employer-paid DPC, employee-paid catastrophic layer. The employer pays the flat monthly DPC fee for all enrolled employees and dependents, and employees choose their own major medical coverage separately, often through a CHOICE Arrangement allowance.
- DPC plus group HDHP. The employer keeps a traditional group HDHP for catastrophic coverage and adds DPC as a supplemental, employer-funded benefit on top of it. Under the One Big Beautiful Bill Act, as of January 1, 2026, a qualifying DPC arrangement with fees of no more than $150 per month for one person, or $300 per month for an arrangement covering more than one person, no longer prevents employees from contributing to an HSA [8].
This is general educational information, not tax or legal advice. Talk with a qualified tax professional about how this applies to your situation.
- DPC plus health sharing for small groups. Some small employers, particularly those who have moved away from a traditional group plan entirely, pair employer-funded DPC with a health sharing arrangement for the catastrophic layer, at a combined cost that can be lower than a traditional small-group plan, depending on the group.
Questions to Answer Before Your Renewal Meeting
- Is there a DPC practice, or a national DPC network, that can actually serve your employees’ location(s)?
- Will DPC replace part of your current plan, or sit alongside it as a new, separate line item?
- Do you want to fund it fully, partially, or make it voluntary and employee-paid through payroll deduction?
- How will you explain a benefit most employees have not heard of, clearly, in your open enrollment materials, without it sounding like a downgrade?
- What is the realistic timeline to have a contract signed and enrollment materials ready before your open enrollment window opens?
Frequently Asked Questions
Is Direct Primary Care a replacement for our group health plan? No. DPC handles primary care only. Employers pair it with a separate plan, such as an HDHP, CHOICE Arrangement, or health sharing arrangement, for hospitalization, surgery, specialist care, and emergencies.
How much does it cost per employee? It depends on the practice and region. A 2026 physician survey put the national average at about $99 per member per month, with lower averages in the Midwest and in rural practices; our guide to Direct Primary Care costs in 2026 has the regional breakdown and sources. Employer contracts with a DPC network can sometimes negotiate volume pricing.
Can employees use HSA funds for DPC if we offer both? Partly. As of January 1, 2026, employees with a qualifying HDHP can keep contributing to an HSA while enrolled in a qualifying DPC arrangement, as long as fees stay within $150 per month for one person or $300 per month for more than one person, and they can use HSA funds for DPC fees they pay themselves. HSA funds cannot reimburse DPC fees the employer pays, including fees paid through pre-tax salary reduction [8].
Is this realistic for a small business, not just a large employer? Yes. Much of the recent growth in employer-sponsored DPC has come from small and mid-size employers specifically, often as an alternative to absorbing another year of steep renewal increases on a traditional small-group plan.
What is the timeline to add this before our 2027 plan year? If your plan year starts January 1, 2027, you want a decision made and a contract in place well before your own open enrollment period, which typically runs in October or November, ahead of the ACA Marketplace’s public window, which opens November 1, 2026 [5][6]. August and September are the right time to be having this conversation, not October.
Next Steps
Adding Direct Primary Care to a benefits package is a decision with a lot of moving parts: network availability, funding structure, HSA compatibility, and how it fits alongside whatever catastrophic coverage layer you already offer. It is worth modeling against your actual renewal numbers before you commit to another year of the status quo.
At Journey Health Advisors, we help employers compare DPC, CHOICE Arrangements, health sharing, and traditional group coverage side by side, with no carrier bias and no pressure toward any single product. If your renewal is coming up, now is the time to have this conversation.
Speak with an advisor at Journey Health Advisors: 1 (844) 580-6055 | journeyhealthadvisors.com/schedule
Related Reading:
- Health benefits solutions for employers
- How Much Does Direct Primary Care Cost in 2026? Real Prices by Region and Practice
- What Is CHOICE (ICHRA)? A Complete Guide for Employers Heading Into Renewal Season
- How to Explain New Health Benefits to Employees During Open Enrollment
- Health Benefits for Small and Mid-Size Employers: Smarter, More Affordable Solutions
REFERENCES
[1] KFF. “2025 Employer Health Benefits Survey.” Kaiser Family Foundation, October 2025. https://www.kff.org/health-costs/2025-employer-health-benefits-survey/
[2] KFF Health News. “Annual Family Premiums for Employer Coverage Rise 6% in 2025, Nearing $27,000.” KFF, October 2025. https://www.kff.org/health-costs/annual-family-premiums-for-employer-coverage-rise-6-in-2025-nearing-27000-with-workers-paying-6850-toward-premiums-out-of-their-paychecks/
[3] Hint Health. “2026 Direct Primary Care Trends Report.” Hint Health / Morningstar, April 2026. https://get.hint.com/direct-primary-care-trends-2026
[4] Health Compiler. “Rise of Employer-Sponsored Direct Primary Care in 2025.” Health Compiler, November 2025. https://www.healthcompiler.com/why-2025-is-the-tipping-point-for-employer-sponsored-direct-primary-care
[5] HealthCare.gov. “Dates and Deadlines for 2027 Health Insurance.” U.S. Centers for Medicare & Medicaid Services, 2026. https://www.healthcare.gov/quick-guide/dates-and-deadlines/
[6] healthinsurance.org. “ACA Open Enrollment Guide.” healthinsurance.org, April 2026. https://www.healthinsurance.org/open-enrollment/
[7] American Academy of Family Physicians (AAFP). “Answers to Six Common Questions About Direct Primary Care.” AAFP In Practice Blog, October 2025. https://www.aafp.org/pubs/fpm/blogs/inpractice/entry/dpc-faqs.html
[8] Internal Revenue Service. “Notice 2026-05: Expanded Availability of Health Savings Accounts under the One, Big, Beautiful Bill Act (OBBBA).” IRS, December 2025. https://www.irs.gov/pub/irs-drop/n-26-05.pdf
Journey Health Advisors | journeyhealthadvisors.com | 1 (844) 580-6055 8810 Blakeney Professional Drive, Suite 100, Charlotte, NC 28277
