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Direct Primary Care vs Traditional Insurance: Which Model Saves You More?

A comprehensive comparison to help you make an informed decision about your healthcare coverage in Albuquerque, NM

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Side-by-Side Comparison

Category
Direct Primary Care
Traditional Insurance
Monthly Cost
Flat monthly membership, often $75 to $150 nationally (Body1MD: $100/month under 50, $150/month age 50+)
Monthly premiums that vary widely by plan, plus deductibles, copays, and coinsurance
Access to Care
Same- or next-day appointments in most cases, direct phone and text access to your doctor
Waits of several weeks are common for routine visits; phone access often goes through a front desk
Visit Duration
Longer, unhurried appointments (Body1MD visits are designed to last up to an hour)
Short appointments, often around 15 minutes, that can feel rushed
Annual Deductible
None on the membership itself; you pay the flat monthly fee
Often $1,500 to $8,000 or more before insurance pays
Included Services
Primary care visits, direct access, and care coordination; what else is included varies by practice
Copays for visits, labs, procedures; many services not covered until deductible is met
Administrative Burden
Minimal: no insurance claims at the practice, transparent membership pricing
Higher: insurance claims, surprise bills, denied coverage, network restrictions
Best For
People who value relationship-based care, need regular access, want predictable costs
People who rarely see a doctor and prefer traditional coverage structures

Understanding Direct Primary Care

Direct Primary Care (DPC) is a membership-based healthcare model that eliminates insurance companies from the primary care relationship. Patients pay a flat monthly fee directly to the practice, often $75 to $150 per month nationally, and in return receive primary care with direct access to their physician, without insurance claims at the practice. At Body1MD, membership is $100 per month under age 50 and $150 per month at 50 and up, month-to-month, with no annual contract and no annual concierge retainer.

This model allows physicians to keep much smaller patient panels than the 2,000 or more patients common in traditional practices, enabling longer appointment times, prompt access, and direct communication by phone or text. Body1MD keeps a deliberately limited panel, so visits are designed to last up to an hour and same- or next-day appointments are available in most cases. What else a DPC membership includes varies by practice; Dr. Hemmen's office can explain how outside labs, imaging and prescriptions are handled before you join.

Supporters of the model point to what more time and easier access make possible: problems raised earlier, chronic conditions followed more closely, and fewer trips to urgent care or the emergency room for issues a primary care physician could have handled. Research on DPC outcomes is still growing, so it makes sense to judge the model on what it offers you directly: time, access, and a predictable price.

Understanding Traditional Insurance

Traditional health insurance operates on a fee-for-service model where patients pay monthly premiums, which vary widely by plan and by how much an employer contributes, plus additional costs including annual deductibles (often $1,500 to $8,000 or more), copays for each visit, and coinsurance for services. This model was designed primarily for catastrophic coverage and hospital care, not routine primary care needs.

In traditional insurance-based practices, physicians typically manage 2,000+ patients to remain financially viable, resulting in short appointments (often around 15 minutes), long waits for scheduling (often several weeks), limited after-hours access, and a transactional rather than relationship-based approach to care. Administrative burden is high for both patients and physicians, with frequent billing disputes, denied claims, and network restrictions.

While traditional insurance provides essential coverage for specialists, surgeries, and hospitalizations, many patients find that their high premiums and deductibles mean they're paying thousands per year while still facing barriers to accessing basic primary care. For healthy individuals who need preventive care and occasional sick visits, premiums and out-of-pocket costs can add up to thousands of dollars a year while relatively little primary care is received.

How to Decide Which Model Is Right for You

Choose Direct Primary Care if you:

  • Value a personal, ongoing relationship with your doctor and want unhurried appointments
  • Need regular primary care access and want same- or next-day appointments
  • Want predictable, transparent healthcare costs with no surprise bills
  • Have chronic conditions requiring ongoing management and coordination
  • Are frustrated with insurance hassles, billing confusion, and administrative burden
  • Can pair DPC with a high-deductible health plan for catastrophic coverage

Choose Traditional Insurance if you:

  • Rarely need to see a doctor and prefer paying only when you use services
  • Are comfortable with 15-minute appointments and longer wait times for scheduling
  • Prefer working within an insurance network and handling claims processes
  • Want all healthcare services bundled under one insurance plan
  • Have employer-sponsored insurance with minimal out-of-pocket costs

Pro Tip: Many patients combine a DPC membership with a high-deductible health plan (HDHP) or health-sharing ministry for catastrophic coverage. This hybrid approach provides primary care access through DPC while maintaining protection against major medical expenses. Some people find it costs less overall than a traditional plan alone; the worksheet below helps you check with your own numbers.

Run Your Own Numbers

We don't publish a typical savings figure, because the answer depends on your plan, your health, and how often you need care. Fill in each blank from your own plan documents and last year's bills, then compare the two totals.

Body1MD Membership + Your Plan

Body1MD membership, under 50$1,200/yr ($100/mo)
Body1MD membership, age 50+$1,800/yr ($150/mo)
Premium for any plan you keep (monthly × 12)$ ______
Deductible and coinsurance you expect to pay$ ______
Outside labs, imaging and prescriptions$ ______
Your Annual TotalAdd the lines that apply

Use the one membership line that fits your age. Month-to-month, no annual contract, and Body1MD does not bill insurance.

Traditional Insurance Only

Monthly premium × 12$ ______
Deductible you expect to reach$ ______
Office visit copays (visits × copay)$ ______
Lab and other copays or coinsurance$ ______
Your Annual TotalAdd the lines above

Your plan's summary of benefits lists the premium, deductible, and copays.

Compare Your Two Totals

Every plan is different, so only your own numbers can answer this. Questions? Call (505) 645-5451. Dr. Hemmen's office can explain how outside labs, imaging and prescriptions are handled before you join.

Frequently Asked Questions

Can I use Direct Primary Care with my existing health insurance?
Yes. Many DPC members keep their existing health insurance for specialist visits, hospitalizations, surgeries, imaging, and prescription coverage while using DPC for their primary care. DPC is not insurance; it's a membership for direct access to your primary care physician. Body1MD does not bill insurance, so your plan stays in place for the care it covers, and the membership sits alongside it.
Is Direct Primary Care covered by insurance?
DPC memberships are typically not covered by insurance, since the model specifically avoids insurance billing. However, some employers offer DPC as a benefit. At Body1MD, members pay the practice directly: $100 per month under age 50 or $150 per month at 50 and up. If you hope to pay from a tax-advantaged health account, check eligibility with your plan administrator before you join.
What happens if I need a specialist or hospitalization with DPC?
Your DPC physician will coordinate referrals to specialists and help navigate hospital care, but specialist visits and hospitalizations are separate from your DPC membership. This is why many DPC patients maintain a high-deductible health plan or catastrophic coverage for major medical expenses. Your DPC doctor serves as your advocate and care coordinator throughout the process, which can help you avoid duplicate tests and get to the right specialist sooner.
How do I know whether DPC will save me money?
It depends on your plan, your health, and how often you need care, so there is no honest typical figure to quote. Use the worksheet above: add up what you pay now in premiums, deductibles, and copays, then compare it with the Body1MD membership ($1,200 a year under age 50, $1,800 a year at 50 and up) plus whatever coverage you keep. Beyond cost, many DPC members value spending less time on insurance paperwork and billing questions. The predictable monthly fee makes healthcare budgeting simpler.
Can I cancel my DPC membership if it's not right for me?
DPC memberships are commonly month-to-month. Body1MD's membership is month-to-month with no annual contract, and Founding 50 pricing is protected as long as your membership stays active. Ask the office about the details of starting or ending a membership before you join. At Body1MD, we want every patient to feel confident in their choice.

Ready to Discuss Your Healthcare Options?

Schedule a consultation with Dr. Hemmen at Body1MD in Los Ranchos de Albuquerque to explore whether Direct Primary Care is the right choice for your health and budget.

Schedule Your Consultation

Month-to-month • No annual contract • No insurance billing