Last week we wrote about why small business owners are rethinking traditional health insurance. The response we heard most was: “This sounds interesting — but what does it actually cost?”
It’s the right question. And it deserves a real answer.
This post is the math. Not a vague promise that DPC will save you money — but an honest breakdown of how the numbers actually work, what variables matter most, and how to think about it for your specific situation.
First, the most important thing to understand: direct primary care is not a replacement for health insurance. It’s a replacement for the primary care portion of your insurance.
Your employees still need coverage for hospitalizations, emergency care, specialist visits, surgery, and imaging. DPC handles everything in between — which, for most people, is the vast majority of their healthcare interactions.
So the financial model has two components:
The strategy is to dramatically reduce what you spend on component #2 by switching to an HDHP, and use a portion of those savings to fund component #1.
To understand what DPC saves, you need to know what you’re currently spending.
Small group health insurance premiums vary significantly by state, plan type, employee age, and number of covered lives. But there is a benchmark. KFF’s 2025 Employer Health Benefits Survey puts the average annual premium at firms with 10 to 199 workers at $9,211 for single coverage and $26,054 for family coverage. Workers at smaller firms also carry a larger share of the family premium than workers at large firms — 36% versus 23%.
That is roughly $768 a month for a single employee and about $2,171 a month for a family, before anyone has actually used the plan. And it keeps climbing: premiums rose 5% for single coverage and 6% for family coverage in 2025.
What do employees get for that? At firms of this size, an average single deductible of $2,631 — with 53% of covered workers facing $2,000 or more — a network that may or may not include their preferred providers, and a primary care system where getting a same-day appointment is the exception rather than the rule.
Here’s where the numbers get interesting.
A high-deductible health plan generally costs less per employee per month than a comparable PPO. How much less depends entirely on your market, your current plan design, and your workforce. This is a number to get from your broker with your actual renewal in hand, not from a blog post quoting a national range.
Direct primary care membership pricing varies by practice, location, and what is actually included. We quote employer groups individually rather than publishing one figure, because what a five-person team needs and what a forty-person team needs are not the same product.
The arithmetic itself is simple. If the premium reduction from moving to an HDHP is larger than the cost of the memberships, you are ahead on cash and your employees have materially better access to care. If it is not, you are not. Which of those is true for your business is a question your broker can answer in an afternoon.
We are not going to publish a savings figure and imply it is yours. The range of real outcomes is wide, and the only number that means anything is the one that comes out of comparing your own plan against the alternative.
What we can say is that for businesses currently on fully-insured traditional plans in competitive markets, the comparison is worth running. For others it is not. Both answers happen.
If you are pairing an HDHP with an HSA — which is standard practice — there is a recent change worth understanding, and it is more specific than most of the coverage of it suggests.
As of January 1, 2026, the One Big Beautiful Bill Act allows someone enrolled in a qualifying direct primary care arrangement to contribute to an HSA and to pay the periodic DPC fee with HSA dollars. Before this, a DPC membership could disqualify a person from contributing to an HSA at all. That is a genuine improvement.
The word doing the work is qualifying. The IRS caps the fee at $150 per month for an individual and $300 per month for a family, indexed for inflation after 2026. The arrangement also has to actually be primary care: one that bundles in prescription drugs, procedures requiring general anesthesia, or laboratory services not typically performed in a primary care setting can fall outside the definition entirely.
So this is real, and it is not automatic. Whether a specific membership qualifies depends on how that membership is built. If HSA treatment matters to your decision, ask any practice you are considering — including us — whether their arrangement is structured to meet the definition, and get the answer confirmed by your own CPA before you rely on it. We will give you and your accountant the specifics of what a membership includes so the question can be answered properly rather than assumed.
We are clinicians, not tax advisors, and nothing here should be read as tax guidance. Any question about the tax treatment of health benefits — what is deductible, how a membership is classified for your business or your employees, HSA interaction, payroll treatment — belongs with your own CPA or tax advisor. The rules depend on your business structure and they change. An answer that is right for another company may be wrong for yours. We are happy to give your accountant whatever documentation they need to make that call.
The most common objection to HDHPs is the deductible. “What if someone gets sick and has to pay $3,000 before insurance kicks in?”
It’s a fair concern. Here’s the context that changes it.
With a DPC membership, the vast majority of healthcare needs — acute illness, chronic disease management, preventive care, lab work, medications — are handled within the membership without touching the deductible at all. The deductible only becomes relevant for things that genuinely require specialist care, imaging, hospitalization, or emergency services.
For most healthy working-age adults, that means the deductible may never come into play in a given year. And for those years when it does, the HSA provides a tax-advantaged way to cover those costs.
The HDHP deductible feels scary in isolation. Paired with DPC, it’s a manageable backstop for the situations that actually require it.
The financial case for DPC goes beyond the premium comparison. There are real costs embedded in traditional insurance-based healthcare that rarely show up in a benefits spreadsheet.
Lost productivity. When an employee has to take half a day off to sit in a waiting room for a 15-minute appointment, that’s a productivity cost that doesn’t appear on your insurance invoice. With DPC, most issues can be handled via a Spruce message or a brief call — often without the employee leaving work at all.
Urgent care and ER overuse. Without a provider they can reach quickly, employees end up in urgent care or the emergency room for things a primary care provider could have handled. Both cost more than a primary care visit, and an ER visit costs dramatically more. Direct primary care removes the reason for most of those trips.
Delayed care becoming expensive care. When employees put off addressing a health concern because accessing care feels difficult, small problems become bigger ones. A chronic condition that’s monitored and managed costs far less than one that goes unaddressed until it requires hospitalization. DPC’s accessibility means issues get addressed early.
The DPC + HDHP model works best when:
It may not pencil out as clearly when:
The honest answer is that there is no universal calculation — it depends on your current plan, your workforce, and your market. Which is exactly why we quote employer groups individually instead of publishing a single number.
Our employer benefits page walks through how the HDHP and DPC comparison works. If you bring your current renewal numbers to a first conversation, we can tell you fairly quickly whether this is worth pursuing for your business — including when the answer is no.
Gregory LaFontaine, PA-C is the co-founder and Director of Men’s Health & Wellness at Retro Health & Aesthetics in Worthington, Ohio. He specializes in concierge primary care, men’s health, and employer health benefits.
