Is Direct Primary Care Worth It? Let's Talk Cost & Savings

A flat monthly fee may sound appealing, but parents need to understand how it performs in everyday situations. Recurring ear infections, routine well-child visits, prescription refills, and late-night fevers all test the value of a healthcare model in very real ways.

For families paying out of pocket, even one urgent care or emergency room visit can cost as much as several months of consistent primary care. That’s why many parents start asking whether a different model makes more sense.

In this guide, we'll take a look at how those savings add up, what the DPC model replaces, and the tradeoffs families should consider when deciding if it is the right fit for their household.

What Is Direct Primary Care and How Does It Work?

DPC operates on a membership model. Your family pays a flat monthly fee directly to your primary care practice, which covers most routine and preventive services your kids need.

You pay each month, and in return, you get  access directly to your healthcare provider for primary care needs including sick visits, well visits, and often telehealth or text messaging with your provider . The copays disappear when you bring your little one in for a checkup. The surprise bills stop arriving after that sick visit for strep throat.

This membership typically covers:

• Primary and preventive care visits for the whole family

• Chronic disease management (asthma, allergies, eczema)

• Basic procedures and screenings

• Direct communication with your provider through phone calls or messaging

The model removes insurance companies from the equation for everyday healthcare, but it does NOT replace insurance and is not insurance. Your child's healthcare provider spends more time with your family and less time filing claims.

How Direct Primary Care Helps Families Save Money

Direct Primary Care practices cover more than 85 percent of most healthcare needs with upfront pricing and no deductibles. Families who pair DPC with a high-deductible health plan save an average of 20 to 30 percent on total healthcare costs, largely by avoiding unnecessary urgent care and emergency room visits. 

DPC creates savings through several channels that traditional insurance-based care cannot match. These savings compound over time, especially for families who use primary care services regularly.

The most immediate savings show up in three main areas:

1. Copays Disappear

The monthly fee eliminates copays for every single appointment with your child's healthcare provider.

When you have three kids and someone always seems to need a checkup or sick visit, those $25 to $40 copays add up quickly. With DPC, you've already paid for visits. Bring your little one in as many times as needed.

2. Wholesale Pricing on Labs and Medications

Many DPC practices negotiate wholesale pricing for labs, medications, and imaging. Your provider might offer:

• Basic lab work at cost, potentially saving you hundreds compared to insurance-negotiated rates

• Generic medications at near-wholesale prices, far below retail pharmacy costs

• Discounted imaging when your child needs an X-ray or ultrasound

3. Fewer Urgent Care and ER Visits

When you can message your child's healthcare provider or reach a triage nurse at 8 PM about a fever and get guidance within an hour, you avoid a $150 urgent care copay. Better access to your primary care provider means fewer situations escalate to expensive emergency care.

One prevented ER visit can pay for several months of DPC membership.

Why Access and Time Matter More Than Families Realize

The indirect financial benefits of better access often outweigh the direct cost savings. When you can reach your child's healthcare provider quickly, you prevent small problems from becoming expensive ones.

Here's how better access translates to real savings:

Same-Day Appointments Keep Problems Small

Same-day or next-day appointments mean you're not waiting a week to see if that ear infection gets worse.

Your child gets treated promptly and recovers faster. You avoid the possibility of complications that might require specialist care or stronger medications. Your little one feels better sooner.

Direct Communication Saves Time and Money

Direct messaging or phone access to your provider saves you from taking time off work for minor concerns. You can:

• Text a photo of a rash and get medical advice

• Call about symptoms and receive guidance within hours

• Ask questions about medications without playing phone tag with the office

Those saved work hours add up to real money.

Longer Visits Mean Fewer Follow-Ups

Your child's healthcare provider actually has time to address multiple concerns in one sitting rather than rushing you out the door after addressing just one issue.

Fewer total appointments mean less disruption to your family's schedule. Fewer days missed from work or school. Less time spent in waiting rooms with sick kids who just want to go home.

What Direct Primary Care Does Not Cover

DPC is not health insurance.

Understanding this distinction prevents dangerous gaps in your family's coverage. DPC handles primary care beautifully but leaves significant healthcare expenses unaddressed.

Three major categories fall outside DPC coverage:

1. Emergency Care 

If your child breaks an arm or you need emergency surgery, DPC won't help with the hospital bill, ambulance ride, or specialist care. You still need health insurance for these scenarios. Your little one's safety depends on having both.

2. Hospitalizations

Any inpatient care, whether planned or unexpected, requires insurance coverage. Your child's healthcare provider can coordinate your care and communicate with hospital staff, but they can't pay for the hospitalization itself.

3. Specialist Care

While your DPC provider can handle many conditions, complex issues need specialists. Insurance covers these referrals, though your provider can often help reduce the need for specialty care through better primary care management.

The Solution? Pair DPC with High-Deductible Insurance

Most families pair DPC with a high-deductible health insurance plan. This combination:

• Covers catastrophic events through insurance

• Handles routine care through DPC

• Often costs less total than traditional comprehensive insurance

You get personalized primary care for your kids and protection for the unexpected.

How to Decide If Direct Primary Care Is Worth It for Your Family

Start by examining your current healthcare usage and costs. Pull up your medical expenses from the past year and see how much you spent on primary care visits, copays, and related services for your kids.

Then ask yourself these questions:

1. How often does your family use primary care?

If you rarely go to the healthcare provider, DPC might not deliver enough value.

Families with young children or managing chronic conditions typically use primary care frequently enough to justify the investment. Kids get sick. If you're at the pediatrician's office every few weeks, those copays add up fast.

2. Do surprise medical bills cause you stress?

If unpredictable healthcare costs disrupt your budget or create anxiety, DPC's predictable monthly fee might be worth it for the peace of mind alone.

The wondering stops. The surprise bills stop arriving in the mail weeks later.

3. Do you value longer visits and direct access?

Some families don't mind the traditional model's limitations. Others find rushed appointments and limited access genuinely frustrating.

Know which type of family you are. If you constantly feel rushed during appointments or struggle to get your questions answered, DPC might solve that problem.

4. Are you comfortable pairing DPC with insurance?

This combination works well for many families, but it requires maintaining two separate healthcare payments. Make sure your budget accommodates both the DPC membership and a high-deductible insurance plan.

So, Is Direct Primary Care Worth It?

DPC is often worth it for families who value convenience, consistent access, strong prevention, and predictable costs. The model excels when paired with high-deductible insurance that covers catastrophic events.

Families who use primary care frequently typically find DPC delivers strong value. Parents who want deeper relationships with their child's healthcare provider appreciate the continuity and time. Families needing extensive specialist care or operating on very tight budgets may find traditional insurance-only arrangements more practical.

If you still need a bit more nudging, compare your current primary care spending and satisfaction against what DPC would cost in both money and peace of mind. The answer becomes clear once you understand what you're actually getting for your investment.

Your little ones deserve healthcare that feels personal, unhurried, and genuinely focused on keeping them healthy. And when you find that in a DPC practice, the value extends far beyond what shows up on a spreadsheet.

Take the Next Step Toward Simpler, More Personal Pediatric Care

At Grove Health Pediatrics, care is built around your child, not a clock or an insurance checklist. Our Direct Primary Care model gives families consistent access to a healthcare provider who has the time to listen, explain, and partner with you as your child grows.

Families receive  primary care visits, same-day scheduling when needed, secure messaging and phone access, telehealth options, and clear pricing with no surprise bills from our office. Memberships begin at $65 per month per child for ages 2 and older, with our Foundations Plan  option available for infants from birth through 24 months.

If you’re looking for pediatric care that feels thoughtful, accessible, and grounded in real relationships, we invite you to connect with Grove Health Pediatrics and explore if our Direct Primary Care model is right for your family.