Does Direct Primary Care Count As Insurance - Know The Facts

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Do you want to know if Direct Primary Care Counts As Insurance? Then you must read this post. You'll find the ideal answer to your query inside. Read to know

Do you want to know if Direct Primary Care Counts As Insurance? Then you must read this post. You'll find the ideal answer to your query inside. Read to know

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November 28, 2022
Does Direct Primary Care Count As Insurance - Know The Facts
Does Direct Primary Care Count As Insurance - Know The Facts

Healthcare has been a topic of national as well as global interest. Especially since the pandemic, it’s gained more attention. Now more than ever many people are seriously thinking about medical coverage and financial ability to withstand health emergencies.

This has also brought into being several new medical care models. One such arrangement that has mushroomed in recent times is called direct primary care or DPC.

It differs from the typical insurance plan and connects patients directly to physicians without the rigmarole of health insurance. But does direct primary care count as insurance? Let’s understand in detail as you read along. 

Quick Summary

This article will help you understand:

  • What is direct primary care?
  • How does direct primary care differ from insurance?
  • Is direct primary care worth it?
  • Does direct primary care count as insurance?
  • Which is best: direct primary care or group health insurance

What Is Direct Primary Care?

Direct primary care is a model where a patient directly pays their primary care provider, say a doctor, for treatment or medicine. They’re the first person you speak with when you have any medical problem. Consistent primary care can lead to longer, healthier lives. 

How Does Direct Primary Care Differ from Insurance?

While a typical health insurance plan covers primary care services, it differs drastically from the DPC model. With the latter, as the name suggests, it only covers expenses for primary care. This means that within the ambit of DPC plans, it does not include emergencies that require hospitalization. 

On the other hand, a mediclaim policy, no matter how basic, provides coverage for a larger gamut of health care services. It includes primary care as well as secondary care services with pre and post-hospitalization coverage.

However, given its wide scope, a health insurance scheme also comes with a more complicated set of requirements, which a DPC plan eliminates by nature.

Further, a primary care model is also more affordable as it does away with middlemen. It entails an arrangement wherein buyers pay a fixed membership fee to primary care physicians in return for accessible and subsidized medical services.

However, is direct primary care enough in terms of medical coverage? Let’s find out.

Is Direct Primary Care Worth It?

While DPC practices are evolving rapidly, they may not be the best bet when it comes to comprehensive health care. The reason is that the scheme doesn’t cover health emergencies that require specialty care, hospitalization, or surgical intervention.

Despite covering recurring or routine medical expenses, direct primary care models are not a replacement for health insurance. For employers, DPC could also mean additional expenses, as it only offers primary care benefits.

In the absence of a complete medical cover, companies could be exposed to higher risks of employee absenteeism, downtime, and plunging revenues, which could otherwise be covered with a robust group health insurance scheme.

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Furthermore, health insurance plans such as the ones with OPD benefits cover most of the features of a DPC plan while extending additional benefits, such as pre and post-hospitalization coverage, to the buyers. This also brings into question the redundancy of direct primary care models as a health care option.

How Loop Can Help!

🟢 At Loop, we provide employees with access to complimentary medical care at the hands of our in-house team of experts and physicians. The service is free of cost and part of our group health insurance plans.
It aims to act upon the exact benefits of a DPC model for zero costs. The idea is to offer employees quality preventive care that’s continuous, and convenient, along with protection from group health insurance so they’re covered from all angles. For more information, fill out the form so our experts can reach out to you.

Does Direct Primary Care Count As Insurance?

As highlighted above, direct primary care doesn’t act as a substitute for health insurance. Although it is commonly mistaken that DPC counts as insurance, it is far from the truth.

Both models vary in terms of their design, wherein DPC works as a fee-for-service subscription model that directly links buyers with primary care practitioners. It is offered by doctors themselves and the fee cannot be reimbursed as part of insurance.

On the other hand, an insurance plan connects the buyer with a wide network of hospitals and health care providers in exchange for an annual fee or premium. It involves the insurance company as the middle link and is a more strategized and streamlined approach to medical care.

Thus, while primary care DPC models offer the services of a local doctor at a subsidized rate and cover standard out-of-pocket costs, it doesn’t factor in health contingencies. For this reason, primary care practices do not amount to insurance and are still less prevalent in the country.

But does this mean that DPC holds no real benefits? Maybe not. Let’s understand its pros and cons in detail and if it makes the right pick for you. 

Which Is Best: Direct Primary Care Or Group Health Insurance

Direct primary care is more affordable as compared to group health insurance. It is therefore a cost-effective option for employers. Further, it provides easy access to medical aid as it directly puts you in touch with the doctor and is therefore a great way to reduce employee absenteeism and downtime.

Having said that, a DPC doesn’t cover secondary medical care and could result in more expenses for an employer in case of employee health contingencies. Further, since a DPC doesn’t amount to insurance, it doesn’t allow companies to legally comply with the government’s requirements of providing mandatory health coverage to employees.

Direct primary care also doesn’t provide any real tax benefits to employers as opposed to group health insurance.

READ MORE: Are Group Health Insurance Premiums Tax Deductible? 

Lastly, in the absence of comprehensive health care, employees may be reluctant to join a company or stick with it in the long run, thus leading to higher retention and talent acquisition costs.

For businesses, a comprehensive group insurance plan thus holds several benefits in comparison to a DPC model. On the other hand, employees can separately avail of a direct primary care model as a supplement to the group insurance plan that covers them.

Avail Comprehensive Health Care With Loop

As stated above, a direct primary care plan is not the best answer when it comes to comprehensive health care. Employers nowadays want to secure the best employee benefits and reduce costs associated with employee absenteeism.

At the same time, they are looking to hire better talent and arrest retention costs. To this effect, a great fringe benefit that can boost employee productivity and revenues is group health insurance.

A sound group insurance scheme provides end-to-end health care support and even covers the ultimate goal of direct primary care. i.e., preventive health care with quick and simple access to medical care. 

At Loop, we provide group health plans that are not only affordable but also come with a range of benefits, such as round-the-clock access to medical practitioners, complimentary wellness sessions, mental health support, and more. 

Our aim is to ensure employees are healthy with continuous, quality care that helps with better business outcomes like reduced absenteeism, enhanced productivity, better morale, and more. 

Let’s help you curate a plan that works for your enterprise. Talk to our experts today!  


1. What are the 3 disadvantages of direct primary care?

Like everything else, there are two sides to direct primary care too. The disadvantages include: 

  • With DPC, you only get access to doctors, but with the number of patients, you have limited access 
  • It does not come in handy during emergencies or serious conditions because, while a doctor sees you, health insurance will help cover the costs like hospitalization, medicines, room rent, ambulance charges, and more. 
  • It’s mandatory for businesses to offer health insurance to employees and DPC isn’t sufficient. Plus, the DPC model doesn’t offer tax benefits, unlike group health insurance. 

2. How much does direct primary care cost?

In this model, patients pay a fixed monthly fee which can range anywhere from Rs. 3000 to Rs 10,000. But this price is just a ballpark figure. The exact amount depends on the provider, the plan, the inclusions, and more. 

Does Direct Primary Care Count As Insurance - Know The Facts
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