Choosing the Right Insurance to Pair with Direct Primary Care

Nicholas Jones
2 days ago
4 min read

One of the most common questions we receive at Clear Health DPC is:

"What insurance should I have if I'm a Direct Primary Care patient?"

The answer depends on your budget, your health needs, and your tolerance for financial risk. While every situation is different, we generally recommend pairing your DPC membership with some form of catastrophic coverage to protect yourself from major medical expenses such as hospitalizations, surgeries, cancer treatment, serious injuries, or expensive specialty medications.

Here is how we typically rank insurance options from our most preferred to least expensive.

Option 1: High-Deductible PPO + HSA (Our Favorite Option)

For many patients, this is the ideal combination.

A High-Deductible PPO paired with a Health Savings Account (HSA) gives you:

Freedom to choose specialists and hospitals
Protection against catastrophic medical expenses
Triple tax advantages through your HSA
The ability to invest HSA funds for long-term growth
Flexibility to use DPC for most routine healthcare needs

Many HSA custodians allow you to invest your HSA balance into low-cost index funds once you reach a minimum account balance. This creates an opportunity to build a tax-advantaged healthcare nest egg that can grow for decades.

While recent federal law changes now allow many DPC memberships to be paid directly from HSA funds, we often encourage patients who can afford it to pay their membership fee out-of-pocket and allow their HSA dollars to remain invested whenever possible. You can save invoices and records for qualified medical expenses and potentially reimburse yourself later. Always consult your tax professional regarding your specific situation.

Best for: Patients who want maximum flexibility, strong financial protection, and long-term tax advantages.

Option 2: Flexible Spending Account (FSA) + Traditional Insurance

If your employer offers an FSA but not an HSA-compatible plan, an FSA can still pair nicely with Direct Primary Care.

Many patients use their annual wellness visit, laboratory testing, and other qualified medical expenses to utilize FSA funds while enjoying the convenience and accessibility of DPC. When your DPC membership is used as part of an annual physical exam and laboratory interpretation, the membership fee can be paid with FSA funds.

Unlike HSAs, FSA funds generally must be used within the plan year, so there is less opportunity for long-term investing. However, FSAs can still provide meaningful tax savings.

Best for: Employees who have access to an FSA through work but not an HSA.

Option 3: Any Affordable Non-HMO Insurance Plan

If an HSA-compatible PPO isn't available, we generally recommend choosing an insurance plan with:

A lower monthly premium
A higher deductible
A broad provider network
No requirement for primary care referral gatekeeping

Whenever possible, we encourage patients to avoid highly restrictive HMO and POS plans.

Why?

Many HMO and POS plans require referrals to flow through a designated in-network primary care physician. Since Clear Health DPC is not contracted with insurance companies, these restrictions can sometimes create unnecessary barriers when patients need specialty care, advanced imaging, procedures, or certain medications.

A PPO plan often provides greater flexibility and fewer administrative hurdles.

Best for: Patients seeking affordable catastrophic protection without restrictive referral requirements.

Option 4: Health Sharing Programs (Budget-Friendly Catastrophic Protection)

For healthy individuals who do not qualify for affordable traditional insurance, a health sharing organization may be worth considering.

One example is Zion HealthShare, which our patients use alongside their membership.

Health sharing organizations are not insurance, but they can provide financial protection against large, unexpected medical expenses at a significantly lower monthly cost.

This option may be particularly appealing for:

Self-employed individuals
Small business owners
Early retirees
Families looking for lower monthly costs

However, it is important to understand that health shares have different rules, exclusions, and limitations than traditional insurance. For example, they can exclude pre-existing conditions. Many common conditions like diabetes, hypertension, asthma etc. are only excluded if you have been hospitalized for the condition within the last year. Be sure to review their guidelines carefully before enrolling.

Best for: Healthy individuals looking for lower-cost catastrophic protection.

What We Don't Recommend

We do not recommend relying on a Direct Primary Care membership alone.

Our membership provides affordable, accessible primary care, but it is not designed to cover:

Hospitalizations
Major surgeries
Trauma care
Cancer treatment
Organ transplants
Prolonged ICU stays
Very expensive specialty medications

Even healthy people can experience unexpected accidents or illnesses.

Think of Direct Primary Care as your day-to-day healthcare solution and pair it with some form of catastrophic protection for the "what if" scenarios.

What About the Oregon Health Plan (OHP)?

For patients who qualify based on income, the Oregon Health Plan (OHP) can be an excellent source of catastrophic coverage.

OHP provides comprehensive health coverage at little or no cost for eligible Oregonians and enrollment is available year-round.

If you think you may qualify, we encourage you to apply:

Oregon Health Plan Application: https://www.oregon.gov/oha/hsd/ohp/pages/apply.aspx
Oregon Health Coverage Information: https://healthcare.oregon.gov

One note: healthcare policy is constantly evolving. Federal and state budget changes could affect eligibility requirements, covered services, or funding levels in future years. We encourage patients to stay informed about changes that may impact their coverage options.

Our Bottom Line

If we were building the ideal healthcare setup for most patients, it would look something like this:

High-Deductible PPO + HSA + Clear Health DPC
Traditional Insurance + FSA + Clear Health DPC
Affordable PPO or EPO + Clear Health DPC
Health Sharing Program + Clear Health DPC
OHP + Clear Health DPC (for qualifying individuals)

No matter which path you choose, our goal remains the same: providing affordable, accessible, relationship-based primary care without the barriers and frustrations that often come with the traditional healthcare system.