Prime Direct Health and your insurance.
Prime Direct Health isn't insurance, and it doesn't replace yours. It handles your day-to-day primary care while your plan covers the big stuff. Here's how the two fit together.
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Prime Direct Health is a direct primary care membership. You pay a flat monthly fee for unlimited primary care visits, direct provider access, and the in-office services that come with it. We don't bill insurance.
That doesn't mean you should drop your insurance. The opposite. Prime Direct Health works best when you keep some kind of coverage in place for the things primary care doesn't handle: hospital admissions, specialist care, surgery, emergencies, and major imaging.
The cleanest setup is Prime Direct Health plus a high-deductible or catastrophic insurance plan. The combined cost is usually lower than a traditional plan, and the day-to-day primary care experience is the one most people have never actually had.
Three common ways to pair Prime Direct Health with insurance.
Pick the one that matches your situation.
A high-deductible plan with an HSA.
A high-deductible health plan (HDHP) gives you a safety net for hospital admissions, surgery, and other large medical expenses, subject to your specific plan's terms. Prime Direct Health covers the day-to-day primary care. Your HSA dollars now pay your Prime Direct Health membership pre-tax, which works out to a 20 to 35 percent effective discount depending on your tax bracket.
For most working-age members, this is the cheapest combined cost and the best care.
A catastrophic plan.
Catastrophic plans have low monthly premiums and only kick in if something goes seriously wrong. Prime Direct Health handles everything below that threshold. Some members also use a healthshare program here as their catastrophic coverage.
Best for members who want minimum monthly insurance cost and a real safety net for the rare worst-case.
Your existing employer plan.
Keep the employer plan. Use Prime Direct Health on top. Your employer plan stays in place for specialists, hospital, and prescriptions. Prime Direct Health becomes your day-to-day primary care, with same-day access and unhurried visits.
Best for members happy with their employer coverage but tired of how primary care actually works under it.
Between jobs or uninsured?
Prime Direct Health can be the foundation of your care while you sort out longer-term coverage. The flat monthly fee gives you a real provider, real visits, and real prices on labs and medications, even if you don't have insurance behind it.
For the things Prime Direct Health doesn't cover (hospital, surgery, specialist care), we'll help you think through affordable options. We're not insurance brokers, but we know the territory and can point you in the right direction. A catastrophic plan or a healthshare program is the most common worst-case backstop.
The 2026 HSA rule.
As of January 2026, federal law (the One Big Beautiful Bill Act, signed July 2025) explicitly allows direct primary care memberships to be paid through a Health Savings Account when paired with a qualifying high-deductible insurance plan.
That's the HSA cap for direct primary care, and our $90 individual rate and family pricing fall well under it.
If you have an HSA and aren't using it for primary care, you're paying for Prime Direct Health with after-tax dollars when you don't have to. Depending on your bracket, that's 20 to 35 percent more than necessary.
Common questions.
Do I have to drop my current insurance to join Prime Direct Health?
No. Prime Direct Health is in addition to insurance, not a replacement for it. The opt-in only changes where your primary care happens. Everything else about your insurance keeps working.
Will Prime Direct Health bill my insurance for any of this?
No. We don't bill insurance, period. Your monthly membership is paid directly to the practice. That's the whole point of the model and it's what lets us run the way we do.
What about Medicare?
Our providers have opted out of Medicare, which is required for most direct primary care practices.
Read the full senior care walkthrough →My employer offers an HDHP. Can I pay for Prime Direct Health with my HSA?
Yes, as of January 2026. The HSA contribution caps are well above what Prime Direct Health costs, so the math works for nearly any household.
Will my insurance cover labs you order?
Whether your insurance covers a specific lab depends on your plan, your deductible, and the test ordered. We can't tell you what your insurance will pay. What we can tell you: we negotiate near-wholesale pricing on labs and pass it through to you, so for most common lab work our cash price is well below what you'd pay through insurance before your deductible kicks in. You see the cash price before we order. If you'd rather run the test through your insurance instead, just let us know.
What about a healthshare?
In most cases, this works. Prime Direct Health handles your primary care. Members typically use their healthshare program for the bigger needs (hospital admissions, specialist care, surgery, emergencies) under whatever rules their specific program operates by. Bring your specific healthshare to a meet and greet and we'll talk through how the two work together for you.
Can I deduct my Prime Direct Health membership on my taxes?
Maybe. The HSA route gets you the cleanest tax treatment. Outside that, medical expenses can be deducted if you itemize and your total medical expenses exceed a certain percentage of your income. Talk to your tax person about your specific situation.
Want to talk through your situation?
Bring your insurance details to a free meet & greet. We'll walk through the math with you, including the HSA option if you have one. No pressure either way.
Schedule a free meet & greet