How Direct Primary Care Works with Your Insurance
This is not an either-or decision. Your insurance and Direct Primary Care each handle a different part of your healthcare, and the two pair up far more comfortably than most people assume.
Almost everyone who looks into VDPC in Portland arrives carrying the same worry, phrased one way or another. Will signing up do something to my insurance? It will not. That is the quick version. Keep reading if you want the full picture of how a membership and a health plan sit alongside one another.
Two Buckets, Two Jobs
Picture two buckets sitting side by side. One holds everything your VDPC in Portland membership takes care of. The other holds everything your insurance takes care of. Nothing spills from one bucket into the other, and neither one gets in the other’s way.
VDPC Membership Covers:
- Unlimited primary care visits, no cap
- Appointments within 2 days
- Reach Ed directly by message, phone, or video
- Managing chronic conditions, follow-ups included
- Medication management and refills
- Annual wellness exams
- Steeply discounted lab pricing
Your Insurance Covers:
- Specialist visits and referrals
- Emergency room and urgent care
- Hospital stays and surgery
- Imaging (MRI, CT, X-ray)
- Prescription drug coverage
- Mental health and specialty care
Questions We Hear Often
Does VDPC bill my insurance?
No, and that is actually one of the reasons the model works. Because we don’t bill insurance for primary care visits, we are not subject to the billing requirements that drive up costs and limit appointment time. You pay your membership fee directly, and we provide your care directly. No claims, no EOBs, no processing delays.
Can I still see specialists and use my insurance for hospital care?
Yes, completely. Your VDPC membership handles your primary care. Everything else, specialists, emergency care, surgery, imaging, runs through your insurance exactly as it does today. The two operate independently, and joining VDPC does not change your insurance coverage in any way.
Can I use my HSA or FSA to pay for my membership?
This depends on your specific plan. Under current IRS rules, DPC membership fees are generally not eligible for HSA reimbursement on their own, however, some people pair a DPC membership with a qualifying high-deductible health plan in a way that allows partial HSA use. We recommend checking with your plan administrator or a tax advisor for your specific situation.
What if I am on Medicare or Medicaid?
Medicare and Medicaid patients are welcome to enroll at VDPC, but there are some important limitations to understand. We are not able to bill Medicare or Medicaid for services, which means your membership fee covers your primary care with us outside of those programs. For services that require Medicare or Medicaid coverage, specialists, hospital care, prescriptions, your benefits remain in place and are not affected by your VDPC membership. If you have questions about how this applies to your situation, reach out and we can talk through it.
What if I lose my insurance?
Your VDPC membership continues exactly as normal. You still have full access to Ed, an appointment within 2–4 business day, direct messaging, and all the primary care services included in your membership. For many people who are between jobs or in a coverage gap, a VDPC membership is what makes that period manageable, you have primary care covered even when everything else feels uncertain.
Do I need insurance to join VDPC?
No. You do not need to have insurance to become a VDPC member. Many of our patients are uninsured or self-employed and use their membership as their primary source of healthcare. For anything that falls outside of primary care, a hospital visit, a specialist referral, we can help you think through your options, but insurance is not a requirement to get started.