A practice that knows your name.
Primary care that runs on your schedule and treats your care with the time it deserves. Here's exactly how Prime Direct Health works alongside your Medicare.
Schedule a free meet & greetPrime Direct Health and Medicare.
Our Prime Direct Health providers have opted out of Medicare. That's a legal requirement for most direct primary care practices. Practically, here's what it means.
Medicare won't be billed for the care you get at Prime Direct Health. You'll pay our flat $120 monthly senior membership directly to the practice. Your Medicare coverage stays active for the rest of your healthcare.
There's a real wrinkle to know about before you decide.
Medicare requires certain covered services to happen through a Medicare-participating provider. The Annual Wellness Visit, which is a free yearly preventive visit under Medicare Part B, falls into this category. So do cognitive and depression screenings and a few related preventive items. Because we're opted out, those specific services can't happen at Prime Direct Health. Most senior Prime Direct Health members keep a separate Medicare-participating provider in the picture for these items.
If you have a Medicare Advantage plan, that adds a second wrinkle. Advantage plans are built around their own provider network, and certain referrals, testing, and specialist care may need to come from a Medicare-participating provider to stay covered. Prime Direct Health isn't going to be in your Advantage plan's network because we're opted out of Medicare entirely.
Many senior members find Prime Direct Health is right for them once they understand how it fits. We want you to have the full picture going in so you can decide.
What Prime Direct Health handles, and what to keep in place.
Most senior members use Prime Direct Health for day-to-day primary care and keep a Medicare-participating provider for the items Medicare requires.
What Prime Direct Health handles
- Same-day or next-day visits when you're sick
- Annual physicals and ongoing wellness visits at Prime Direct Health (the Medicare Annual Wellness Visit happens elsewhere)
- Chronic condition management (blood pressure, diabetes, cholesterol, thyroid, and the like)
- Medication management and refills
- In-office procedures (EKG, spirometry, urinalysis, skin tag and mole removal, ear lavage, ingrown toenail care, and more)
- Mental health support for anxiety and depression
- Direct phone and text access to your provider
- Specialist referrals on Original Medicare, with us coordinating follow-up where we can (on Medicare Advantage, referrals may need to come from your plan’s network provider to stay covered)
What you'll want to keep in place
- A Medicare-participating provider for your Annual Wellness Visit and Medicare-required preventive services
- Your Medicare or Medicare Advantage coverage for hospital admissions
- Coverage for surgery and skilled nursing
- Coverage for specialist visits (cardiology, orthopedics, oncology, and others). On Medicare Advantage, those referrals usually need to come from your Medicare-participating provider.
- Coverage for emergency room visits
- Coverage for imaging (X-ray, CT, MRI, ultrasound)
- Major prescription drug coverage (Part D)
What Prime Direct Health looks like for senior members.
The pieces that matter most at this stage.
More time, every visit.
30 to 60 minutes with your provider, every time, instead of 13. That changes what’s possible in a single visit.
Same-day access.
When something comes up and you don’t want to wait three weeks for an appointment, you call us and we see you today or tomorrow.
A real person on the phone.
No phone tree. No portal-only communication. The same small staff who knows your face also knows your voice.
One provider, every time.
Deedee sees you. Not a rotating cast. The conversation picks up where the last one ended.
Medication review, in depth.
If you’re on a long list of prescriptions, we have the time to actually look at the list, not just refill it. Interactions, dosing, what could come off.
Family on the same plan.
A spouse, adult kids, or grandkids can join too. Most senior memberships are solo or two-person households, so family pricing doesn’t always come into play. When it does, members 65 and up stay on the $120 senior rate. Everyone else under 65 falls under standard family pricing.
Is Prime Direct Health right for you?
It's a good fit if
Prime Direct Health works well for senior patients who want a direct relationship with a primary care provider who knows them, real time in their visits, and transparent pricing on anything that falls outside the membership. It works if you're comfortable keeping a separate Medicare-participating provider in the picture for your Annual Wellness Visit and any Medicare-required referrals.
It's probably not if
It probably isn't the right fit if you want one provider to handle everything Medicare touches without coordinating with another office. That's a real preference, and we'd rather you go to a Medicare-participating PCP who can run it all under one roof than join Prime Direct Health and feel pulled in two directions.
The fastest way to figure out which one you are: schedule a free meet & greet. We'll walk through your specific situation together.
Common questions from seniors.
Can I keep seeing my cardiologist or other specialists?
Yes, with one caveat. Your existing specialists keep doing what they’re doing. If you’re on Original Medicare, your specialist relationships continue normally. If you have a Medicare Advantage plan, your plan may require referrals or orders from a Medicare-participating provider to stay covered. In that case, you’ll want to route those referrals through your Medicare PCP. Prime Direct Health handles your day-to-day primary care and coordinates whatever we can on our end.
What about my prescriptions?
Your Part D coverage stays intact. We can prescribe medications and send them to your usual pharmacy. For some common generics, our cash pricing through the office is cheaper than your Part D copay. We’ll check both options.
What if I need the hospital?
Hospital care happens through your existing Medicare coverage. If you’re admitted, your Medicare benefits work as they normally would, with no change because you’ve joined Prime Direct Health. After you’re discharged, Prime Direct Health handles the follow-up and helps you stay on track at home.
Will I pay for anything besides the $120 monthly fee?
Visits, in-office procedures, telehealth, and direct provider access are all covered by the membership. Labs drawn in clinic and medications filled here are billed separately at near-cost prices, and we show you the price before we order anything. No copays, no surprise bills.
Do I have to drop my Medicare to join Prime Direct Health?
No. Your Medicare stays fully active. The opt-out only changes what gets billed to Medicare for your care at Prime Direct Health specifically. Your Medicare coverage continues to apply to hospital admissions, specialists, imaging, prescriptions, and the rest of your existing care. The one part to know about is the Medicare-covered preventive services (the Annual Wellness Visit and a few related items), which still need to happen through a Medicare-participating provider. The section above walks through this.
What about the Annual Wellness Visit my Medicare covers?
The Annual Wellness Visit is a free yearly preventive visit covered under Medicare Part B. It includes a health risk assessment, cognitive and depression screenings, and a personalized prevention plan. Because Prime Direct Health is opted out of Medicare, the AWV needs to happen with a Medicare-participating provider. Most senior Prime Direct Health members keep a separate Medicare PCP in the picture for this visit and a few related preventive items. Prime Direct Health handles the rest of your primary care.
What if I have a Medicare Advantage plan instead of Original Medicare?
There are a couple of extra things to know with Medicare Advantage. Advantage plans are built around their own provider network. Specialist referrals, lab orders, and certain testing usually need to come from a Medicare-participating provider in your plan’s network to stay covered. Prime Direct Health isn’t going to be in your Advantage plan’s network because we’re opted out of Medicare entirely. That means you’ll typically keep your Advantage plan PCP in the picture for the orders and referrals your Advantage plan requires, and use Prime Direct Health for your day-to-day primary care. Bring your specific Advantage plan details to a meet and greet and we’ll walk through how it would actually work for you.
What if my family wants to join too?
Family pricing makes it straightforward. Members 65 and up stay on the $120 senior rate. Adult children pay $90, kids and additional family members under 65 are billed under family pricing. We’ll set up a single account for the household.
Want to talk it through?
Schedule a free meet & greet. Bring your Medicare card, your medication list, your spouse, and your questions. We'll walk through the specifics and you'll know whether Prime Direct Health is right for you.
Schedule a free meet & greet