Insurance & Coverage

Do I Still Need Health Insurance With Direct Primary Care?

Short answer: yes, we recommend it. A Direct Primary Care (DPC) membership covers your everyday primary care, but it is not health insurance. You still want coverage for the rare, expensive events membership doesn’t handle.

What DPC covers and what it doesn’t

Membership covers the care you use most: sick visits, follow-ups, preventive checkups, chronic condition management, and texting your care team. It does not pay for emergency room visits, hospital stays, surgery, or specialist care. A DPC membership also does not count as minimum essential coverage under the Affordable Care Act.

The common pairing: DPC plus a high-deductible plan

Many members pair DPC with a high-deductible health plan (HDHP) or a catastrophic plan. Because DPC handles routine care, you rarely touch the deductible for everyday needs, and the insurance plan is there for a broken bone, a hospitalization, or a surgery. These plans usually carry lower monthly premiums than plans with low deductibles.

New for 2026: more plans work with an HSA

Under the 2025 federal tax law and IRS Notice 2026-5, bronze and catastrophic plans bought through the ACA Marketplace now count as HSA-compatible, and DPC membership no longer blocks HSA contributions as long as fees stay within $150 per month for one person or $300 per month for a family. That makes it easier to pay for both your DPC membership and your deductible with pre-tax dollars.

Where Floridians shop for coverage

Florida residents buy individual plans through HealthCare.gov during open enrollment, or through an employer. Catastrophic plans are generally limited to people under 30 or those who qualify for a hardship exemption. A licensed insurance agent or HealthCare.gov can help you compare options.

If you choose not to carry insurance

Some people choose DPC alone. That is your decision, but it leaves you exposed to the full cost of emergencies and hospital care. Your Cavea Health care team can talk through the tradeoffs with you; we don’t sell insurance and have no stake in which plan you pick.