What is direct primary care, and does it work with an HSA?

In a direct primary care model, the employer pays a flat monthly fee per member to a primary care practice. Employees get unlimited visits, same-day or next-day appointments, longer visits, texting access to their doctor, and often discounted labs and generic drugs, with no copay.

The value comes from what happens downstream. A primary care doctor who actually has time to manage a diabetic or catch something early keeps people out of the ER and the hospital. A good DPC partner also refers employees to high-value specialists and facilities, which ties right back to site of care.

The HSA question has been settled. Starting in 2026, DPC no longer disqualifies an employee from an HSA, as long as fees stay at or below $150 a month for an individual or $300 for a family.

What to watch for: DPC only pays off if employees use it, so location and communication matter. If the practice is 40 minutes from where your people live, it doesn't matter how good it is. And like any program, decide up front how you will measure whether it worked.

The bigger version of this idea is direct contracting, where your plan negotiates a price straight with a hospital or surgery center, often as a bundled case rate for something like a knee replacement. Both work best in self-funded plans.

Questions to ask

Where do our employees live relative to DPC or near-site clinic options?
How would a DPC fee interact with our HSA plan?
Which procedures drive the most spend in our plan, and is there a bundled price available locally?

What is site of care navigation, and does it actually save money?

The same MRI, colonoscopy, or infusion can cost two or three times more in a hospital outpatient department than at an independent imaging or surgery center. Navigation programs guide employees to high-quality, lower-cost sites before the claim happens, usually with an incentive. It is one of the fastest ways to cut spend without cutting benefits, as long as savings are measured honestly.

How do underwriters actually price our renewal?

Your renewal is a number the carrier decides, not one it simply calculates. The underwriter projects your claims, adds trend, blends in a manual rate based on credibility, applies pooling charges for large claims, then adds retention for admin, taxes, commissions, risk, and profit. Every one of those inputs has a range, which is why two carriers can look at the same data and come back 15 percent apart.

When should we start working on our health plan renewal?

Five months or more before the effective date. Requests for quotes typically go out three to four months before renewal for fully insured groups and four to five months out for self-funded and captive groups, because stop loss quotes and lasers depend on current large claim detail. Most renewals fail because they start 60 days out.