What a Direct Primary Care Membership Covers

A direct primary care membership typically covers the everyday care you would normally receive from a primary care doctor for one recurring monthly fee. Depending on the practice, that can include routine visits, sick visits, preventive care, chronic condition management, and certain in-office services without a separate copay each time you see your doctor.

The important distinction is that not everything available through a DPC practice is necessarily included in the membership fee. Labs, imaging, medications, and other services may be included, offered at a separate member rate, or handled outside the practice. Knowing that difference makes it much easier to understand what you're actually paying for.

How Does a Direct Primary Care Membership Work?

Direct primary care, often called DPC, uses a membership model rather than billing insurance for the primary care covered by the membership. Patients pay the practice directly, usually through a monthly fee, and can use the included services without a copay for each covered visit.

The model can also allow practices to maintain smaller patient panels. According to the American Academy of Family Physicians, DPC physicians reported caring for an average panel of about 402 patients. Smaller panels can give physicians more time for appointments and ongoing patient communication.

How Much Does a Direct Primary Care Membership Cost?

Membership fees vary by practice, location, age, and what the membership includes. AAFP data found that adult DPC membership fees commonly fall between about $50 and $100 per month.

At Palmetto Proactive, the P3 membership currently costs $80 per month for an adult. The membership includes primary care visits and other specified services without a separate copay for each covered appointment. Services outside the membership may have an additional cost, which is why it's important to review what a particular DPC plan includes rather than assuming all memberships work the same way.

What Does a DPC Membership Cover for Everyday Care?

The main purpose of a direct primary care membership is ongoing access to primary care without paying a separate copay for each covered visit. Exactly what is included varies by practice, but DPC memberships may cover:

• Sick visits with same-day or next-day availability

• Annual physicals and preventive screenings

• Ongoing care for conditions such as diabetes, high blood pressure, high cholesterol, and thyroid disorders

• Evaluation and treatment of acute illnesses and minor injuries

• Certain minor procedures, such as stitches, skin biopsies, or ingrown toenail removal

• Flu shots and other available immunizations

• In-office testing such as EKGs

• Communication with the care team between appointments

DPC practices also tend to emphasize longer appointments and greater access to the physician. With fewer patients in the practice, there may be more time to discuss a chronic condition, work through symptoms, review medications, or address multiple concerns during the same visit.

What is included still depends on the individual membership. A service offered by a DPC practice may be included in the monthly fee, available for an additional member price, or referred elsewhere.

Are DPC Visits Unlimited?

Some DPC memberships allow patients to schedule covered primary care visits as needed without a per-visit copay or an annual visit limit. However, “unlimited visits” does not mean that every service a practice offers is included at no additional cost. The membership agreement should explain which visits and services are covered.

Palmetto Proactive's own utilization data offers an example of how members use that access. Its members average 4.36 visits per year, while members managing chronic conditions average 7.21 visits per year. 

For patients who need ongoing monitoring, the membership structure removes the added copay that might otherwise accompany each covered follow-up visit. That can make it easier to schedule another appointment when a condition, medication, or symptom needs to be reassessed.

Are Labs, Imaging, and Prescriptions Included in a DPC Membership?

Not every service available through a direct primary care practice is included in the monthly membership fee. Some services may be included, while others are available to members at a separate price. The details vary by practice, so it is important to distinguish between included services and services available at member rates.

Are Lab Tests and X-Rays Included?

Some routine testing may be performed through a DPC practice, but whether it is included depends on the membership. Palmetto Proactive offers in-house lab work to members at rates close to wholesale cost. 

This means that having access to lab testing through the practice does not necessarily mean every test is covered by the monthly fee. Members can ask about the cost of a particular test before having it performed.

Does a DPC Membership Cover MRI or CT Scans?

Advanced imaging such as MRI and CT scans is generally separate from the primary care included in a DPC membership. Some practices may have arrangements that give members access to imaging at published cash or member rates.

Palmetto Proactive members can use the Palmetto Proactive Imaging Center for MRI, CT, and X-ray services without billing insurance. These scans are not included in the monthly membership fee. Instead, members have access to preferred pricing, and the convenience of direct scheduling.

Patients with insurance can still compare those prices with what they would owe through their health plan, particularly when they have not met their deductible.

Are Prescriptions Included in Direct Primary Care?

Prescription medications are generally not included in the DPC membership fee. However, some practices offer programs that can reduce the cost of certain medications.

Palmetto Proactive members have access to a prescription savings program for eligible medications. Patients can compare the available price with their insurance copay or other pharmacy pricing to determine which option makes sense for them.

Does Direct Primary Care Replace Health Insurance?

No. A direct primary care membership covers primary care provided through the practice, but it is not a substitute for health insurance. Insurance remains important for larger or unexpected medical expenses outside the scope of primary care.

Services that are generally outside a DPC membership can include:

1. Hospital stays and emergency room care

2. Care from specialists, such as cardiologists or orthopedic physicians

3. Surgery and advanced procedures

4. Certain forms of long-term pain management

5. Services or vaccinations not offered through the DPC practice

Your primary care doctor can still remain involved when you need care elsewhere. Depending on the situation, that may include making a specialist referral, sharing relevant medical information, or helping you understand follow-up care after treatment outside the practice.

The important distinction is that DPC pays for access to primary care, while health insurance helps protect against medical expenses beyond that primary care relationship.

Can You Pay for a DPC Membership With an HSA?

As of January 1, 2026, federal law allows otherwise eligible individuals participating in certain direct primary care arrangements to contribute to a Health Savings Account (HSA). HSA funds can also be used tax-free to pay qualifying periodic DPC membership fees.

This makes it possible for eligible patients to use HSA dollars toward a qualifying DPC membership while maintaining coverage for medical needs outside the practice. The rules depend on the DPC arrangement and the patient's health coverage, so eligibility should be considered separately from whether a particular service is included in the membership.

Palmetto Proactive explains the new rules in more detail in its article on South Carolina's 2026 HSA changes and direct primary care.

How Is Direct Primary Care Different From Traditional Primary Care?

The main difference is how primary care is paid for. Traditional practices generally bill an insurance plan for covered services, and patients may also be responsible for copays, deductibles, or other out-of-pocket costs. A DPC practice instead charges a recurring membership fee for the primary care included in its agreement.

The membership model can also affect how patients use their primary care practice. Depending on the DPC practice, differences may include:

• No separate copay for covered primary care visits

• Smaller patient panels and more time for appointments

• Same-day or next-day appointment availability

• Direct communication with the care team between visits

• Upfront pricing for services that are not included in the membership

Neither model eliminates the need for care outside a primary care office. The important question is what a particular DPC membership includes and how it works alongside your health coverage.

Can Employers Offer Direct Primary Care Memberships?

Yes. Some employers offer direct primary care as an employee health benefit. Instead of employees purchasing memberships individually, the employer may cover some or all of the membership cost and give employees access to participating DPC practices.

Palmetto Proactive offers an employer membership for South Carolina businesses that want to provide employees with access to its P3 primary care model. The services available through an employer-sponsored membership depend on the specific arrangement.

What Should You Ask Before Joining a DPC Practice?

Direct primary care memberships are not identical, so comparing the details matters more than simply comparing monthly fees. Before joining a practice, consider asking:

• Which primary care visits are included in the monthly fee?

• Are covered visits unlimited, or is there an annual limit?

• Which labs, tests, vaccines, and minor procedures are included?

• Which services have an additional member price?

• How quickly can members typically get an appointment?

• Can members contact the care team between appointments?

• How are specialist referrals and outside care coordinated?

• What happens if you need emergency or hospital care?

• Can eligible members use HSA funds for the membership?

• What are the enrollment and cancellation terms?

Getting clear answers to these questions can help you understand what the monthly fee actually covers and which healthcare expenses remain separate.

Understanding Your Palmetto Proactive Membership

Palmetto Proactive's individual membership provides details about the primary care and other services available through its P3 plan. Because some services are included while others are available at separate member rates, reviewing those details can help you understand what to expect before enrolling.

Palmetto Proactive serves patients through multiple practices across South Carolina. You can view the locations to find the office most convenient for you.