What Is Direct Primary Care, and How Is It Different From Insurance?

How do you get primary care when your insurance makes every visit feel like a guess? One answer is direct primary care. At Oasis Healthcare in Grafton, Wisconsin, direct primary care is one of three ways in, alongside commercial insurance and self-pay.

This guide covers what direct primary care is, how it differs from health insurance, and who it tends to fit. It also covers our Oasis Healthcare membership pricing in Grafton and a 2026 federal rule on using an HSA for direct primary care.

What Is Direct Primary Care?

Direct primary care, often shortened to DPC, is a membership model for primary care. You pay the clinic one fixed monthly fee. That fee covers your everyday primary care, so there's no insurance claim for each visit.

Primary care is the care you use most. It includes sick visits, check-ups, managing an ongoing condition, and questions about your health.

Because the rate is published, you know the cost before you walk in. There's no bill weeks later. You don't have to check whether you've met your deductible first.

How Direct Primary Care Differs From Health Insurance

Health insurance and direct primary care do two different jobs.

Insurance protects you from large, unpredictable costs. It spreads risk across many people and pays for covered services under your plan's rules. Most plans ask you to pay a deductible first. After that, you usually pay a copay or a share of each bill.

That structure works well for a hospital stay or surgery. It can make a routine sick visit hard to price ahead of time.

Direct primary care covers everyday care at a set monthly price. There's no claim, no deductible, and no copay for the care your membership includes. It does not pay for hospital stays, emergency room visits, surgery, or outside specialists.

Here's how the two compare side by side.

What you pay. With insurance, you pay a monthly premium, plus your deductible, copays, and coinsurance. With direct primary care, you pay one flat monthly fee to the clinic.

What it's built for. Insurance is built for large and unexpected medical costs. Direct primary care is built for everyday primary care.

How a visit is paid. With insurance, the clinic bills your plan, and you pay your share. With direct primary care, your membership fee covers included care.

Hospital and emergency care. Insurance covers these under your plan's terms. Direct primary care does not cover them.

Knowing the cost ahead of time. With insurance, it depends on your plan and your deductible. With direct primary care, you know the cost, because the rate is published.

Direct Primary Care Works Alongside Your Insurance

Most patients pair a membership with health insurance. Keep your insurance for the big things, like hospital stays and specialist care. Use your membership for everyday care here in Grafton.

That pairing is common with a high-deductible health plan. On those plans, you often pay full price for routine visits until you reach the deductible. HealthCare.gov explains how a high-deductible health plan works if you want the details. A flat membership turns those routine visits into one predictable monthly cost.

Some patients have no insurance at all. For them, a membership gives steady access to primary care at a known price. We still suggest talking with a licensed insurance agent about coverage for emergencies and hospital care.

Who Direct Primary Care Tends to Fit

Direct primary care fits some situations especially well.

• High-deductible plan holders. You keep your plan for major costs and use the membership for everyday visits.
• Small business owners. You know your rent and payroll to the dollar. A flat membership gives your healthcare costs the same predictability.
• People without insurance. Early in a career or between jobs, a membership keeps you connected to primary care.
• People retiring before 65. Medicare starts at 65. If you leave employer coverage earlier, a membership can cover your primary care in the gap.
• Families. One family rate covers everyday care for everyone in the household.

How the Oasis Healthcare Membership Works

Our membership option has one flat, published rate, billed monthly. You can also pay annually.

• $99 per month for an individual
• $249 per month for a family, as a maximum
• $149 per month for specialty care, which includes weight loss care, specialist care, and patients 65 and older

Oasis Healthcare is clinician-owned, and our nurse practitioners manage your care. Our care runs from illness to wellness, for patients from childhood through adulthood.

Membership is one route. You can also use commercial insurance, or pay a flat self-pay rate per visit. Whatever your coverage, there's a way in. Compare every payment option at Oasis Healthcare to see which one fits you.

Can You Use an HSA for Direct Primary Care?

Starting January 1, 2026, the answer can be yes. The One Big Beautiful Bill Act, signed in July 2025, changed how health savings accounts treat direct primary care. Before that, joining a DPC practice could stop you from contributing to an HSA.

Here is what changed, according to the IRS guidance on HSAs and direct primary care:

• A qualifying direct primary care arrangement no longer blocks HSA contributions.
• You can pay qualifying membership fees with HSA funds.
• The fee limit is $150 a month for one person and $300 a month for an arrangement covering more than one person.
• The arrangement must cover primary care only, for one fixed fee. Prescription drugs other than vaccines, procedures that need general anesthesia, and some lab services fall outside that definition.

These rules are new, and the IRS is still refining them. Your HSA administrator can confirm how they apply to your account. If you have questions about eligibility or pricing, reach out to our team at (262) 421-8961.

Questions to Ask Before You Join Any Membership

A good clinic answers these clearly before you sign up.

• What does the monthly fee include, and what costs extra?
• How do I book a visit, and how soon can I be seen?
• Can I keep my insurance for hospital and specialist care?
• Is there a minimum commitment or a fee to cancel?
• Can I pay with my HSA?

Insurance, Self-Pay, or Membership: There's a Way In

Healthcare can feel confusing, and the cost question often keeps people from booking at all. At Oasis Healthcare, every route is welcome. Commercial insurance, self-pay, and membership all get you in the door.

Not sure which one fits? We're here for you. Book a visit with Oasis Healthcare in Grafton, or call (262) 421-8961, and we'll walk you through your options.