How to Make the Most of Your Insurance with Direct Primary Care

Direct Primary Care (DPC) offers a unique approach to healthcare, prioritizing affordability, accessibility, and a personalized relationship with your provider. At MainelyNP Primary Care in South Portland, you’ll work with a Nurse Practitioner who listens, takes the time to understand your unique health needs, and builds a trusting relationship with you—all without the typical constraints of traditional healthcare.

DPC removes the insurance and administrators from the exam room and without them dictating what can and can not be done or reimbursed, we can actually get to know each other and create personalized care plans that actually improve your health. DPC covers most of your primary care needs like managing acute and chronic conditions, routine physicals, discount labs and medication, and spending a lot more time on health promotion. We can't do everything in our DPC clinic so many patients benefit from using their insurance alongside their DPC membership. Here’s how to maximize both:

• Use Insurance for Specialist Visits & Hospital Stay

With DPC, you have comprehensive primary care, but if you need specialized care, your insurance can bridge the gap. Traditional healthcare often has inconsistent provider relationships and frequent referrals, which can make it hard to feel seen and understood by specialists. With DPC, we coordinate those referrals thoughtfully, ensuring continuity of care and that any specialist you see has the full picture of your health. If you have a complex chronic condition we want you to have the care you need.

• Coverage for Labs & Procedures

Traditional healthcare can often bring surprise bills after labs and imaging, but with DPC, you have transparency and choice for each service, without hidden fees. At MainelyNP, we offer discounted rates on many routine labs and procedures preformed in house are free. We are contracted with Quest lab and you'll save up to 95% on routine labs and we can utilize your insurance for more complex tests if they are covered. 

• Prescription Savings

At MainelyNP we can often provide affordable in-house or wholesale medications, helping patients avoid the unpredictable prices seen at retail pharmacies. For brand-name or specialty medications, using your insurance can cover costs when needed. This dual approach makes sure that all your prescriptions are as cost-effective as possible—without compromising accessibility or transparency.

• Catastrophic Coverage for Peace of Mind

DPC provides the everyday care that keeps you healthy, with immediate access to your provider for any health questions or urgent needs. When paired with a high-deductible insurance plan, you have essential coverage for emergencies or major medical events, which traditional healthcare often limits by access and long wait times.

• How to Choose Insurance & DPC

Insurance Alone: Can result in high costs due to premiums, deductibles, copays, and potential surprise bills. Time with the provider may be limited, and the patient may need to see multiple providers. In 2022, my individual costs for my personal healthcare were roughly $4,500 with a low deductible employer based plan. This included 2 primary care visits, 1 blood draw, pap and mammogram.

DPC Alone: Offers predictable, lower costs for comprehensive primary care, often with discounted labs and medications. It does not cover specialist visits or catastrophic events. If I had used DPC alone in 2022, my individual costs would have been roughly $1,800. I could have had the same services, but would have had unlimited primary care visits. 

DPC & Insurance: Combines the affordability and accessibility of DPC for primary care needs with insurance coverage for specialists and emergencies. This approach optimizes care access and cost-efficiency, with fewer out-of-pocket expenses. If I had used a high deductible employer based plan with a DPC in 2022, my individual costs would have been roughly $3,560. I would have had all the same coverage, the safety to cover a catastrophic event, AND I would have had unlimited access to my primary care provider and saved $1,000.

• What Next?

In contrast to the common limitations of traditional healthcare—such as limited access, inconsistent relationships, rushed visits, and unexpected bills—MainelyNP brings you a personalized, accessible approach. In DPC, you get health support from someone who truly knows you, with transparent and affordable care, and still the option to use insurance as needed for the big ticket items like imaging and specialty care. This is a personal choice for people and some will choose to continue the low deductible insurance and opt for DPC for the personalized care and increased access. For others, using a DPC with either a high deductible insurance plan or a health share can be the right choice. You’ll have the personalized care of DPC and the safety and peace of mind that comes with knowing a hospitalization or surgery will be covered by the high deductible insurance or health share plan. Check out the resources below to help you figure out what will work best for you and your family!

Taro Health is a Maine based health insurance company that prioritizes primary care and mental health care - they pay for your DPC membership and no copay for mental health visits.

DPC and insurance through your employer or from the marketplace.

Consider a local health share like The LeifheitGroup

Don't know how to choose an insurance plan? Check out this article by NerdWallet. 

Still have questions? Contact us by phone, email, or schedule a FREE meet & greet with NP Amy!

We are accepting new primary care patients in South Portland and can't wait to meet you!