Membership Models Comparison¶

Quick Summary: Most DPC practices use one of three simple approaches: (1) Individual vs. Family pricing with a family cap, (2) Age-based tiers, or (3) Annual membership + per-visit fee. Pick one and keep it simple—patients should understand your pricing in 30 seconds.

Table of Contents¶

• The Three Common Models
• What to Include in Membership
• Annual Payment Option
• Employer Contracts
• Models to Avoid
• Checklist

The Three Common Models¶

Model 1: Individual vs. Family Pricing¶

Simple two-tier approach with a family cap.

Example (Family of 4): - 2 adults + 2 children: $200/month (at family cap)

Why Practices Use This: - Simplest to explain and administer - Families know their maximum cost upfront - Encourages whole-family enrollment - No tracking age changes - A family cap of $300/month or less keeps HSA-holding members eligible (see the 2026 HSA box under Model 2)

Practices Using Model 1: - Ciampi Family Practice (South Portland, ME) — $60/month individual; family discounts available

Model 2: Age-Based Tiers¶

Pricing varies by age bracket, reflecting expected care utilization.

Example (Family of 4 with 2 adults age 42, 2 kids): - 2 adults @ $85 + 2 kids @ $35 = $240/month (or cap if lower)

Why Practices Use This: - More accessible for younger patients - Reflects actual utilization patterns - Attracts healthy young adults at lower entry price - Survey data: 66% of practices with variable pricing use age-based discounts

Practices Using Model 2: - NeuCare (Lawrence, KS) — Adults $79/mo, Children $59/mo - Holton Direct Care (Holton, KS) — $10-$100/month based on age - Stand Up Family Medicine (Marietta, GA) — Pediatric $69, Adult $129, Senior $149, Family $300

Model 3: Annual Membership + Per-Visit Fee¶

Lower annual fee with a flat charge per visit.

Example: - $1,250/year membership + $35/visit - Annual physical included; acute visits $35 each

Why Practices Use This: - Lower barrier to entry for patients - Patients pay proportionally to usage - Predictable base revenue plus visit income - Appeals to healthy patients who visit infrequently

Practices Using Model 3: - Osteopathic Center for Family Medicine (Hampden, ME) — $1,250/year + $35/visit; preventive visits free

National DPC Pricing Ranges¶

The national average adult membership was $98.64/month in the State of DPC 2026 survey (465 practices, data collected October–November 2024): West $113, Northeast $110, South $98, Midwest $80; urban $110, rural $82. The ranges below are broader estimates drawn from practice websites and the survey.

Sources: State of DPC 2026 (DPC Alliance and Hint Health); the AAFP DPC overview cites a broader $50-$100/month range. Children and family-cap figures are estimates.

What to Include in Membership¶

Keep this simple too. Everything routine is included; specialized add-ons cost extra at transparent prices.

Included in Membership: - Unlimited office visits - Same-day or next-day appointments - Secure messaging with physician - Phone and video consultations - Annual wellness exam - Basic in-office procedures (ear lavage, wound care, suture removal) - Care coordination and referrals - Prescription management

Additional Cost (at wholesale + small markup): - Labs (passed through at cost or cost + 15-20%) - Procedures requiring supplies (joint injections, biopsies, IUD placement) - Dispensed medications - Vaccines (administration included, patient pays vaccine cost) - Imaging (coordinated at wholesale pricing)

Not Included: - Specialist visits - Hospital care - Emergency services

Annual Payment Option¶

Offer a discount for annual prepayment:

Example: - Monthly: $85/month ($1,020/year) - Annual: $918/year (10% discount)

Benefits: - Improved cash flow - Reduced payment processing fees - Patient commitment for full year - Members with an HSA may be able to pay the fee of a qualifying arrangement from HSA funds (see the 2026 HSA box above); FSA treatment depends on the plan, so ask a tax advisor

Important: Have a clear refund policy for patients who move or have other qualifying life changes.

Employer Contracts¶

As your practice grows, employers may approach you about covering their employees.

Typical Employer Pricing: - Per Employee Per Month (PEPM): $100-$150 - Often 10-15% below individual rates due to volume - Dependents at additional cost - Keep employee-only rates at or below $150/month and family tiers at or below $300/month so employees on high-deductible plans keep their HSA eligibility (see the 2026 HSA box above)

Keep it simple: - Same comprehensive coverage as individual members - Payroll deduction simplifies collection - Start with one small employer before scaling

See the Employer Contracts Guide and Pricing Your Practice for more on employer contracts.

Models to Avoid¶

Multi-Tier Service Levels (Basic/Standard/Premium)¶

Problems: - Patients feel "nickel and dimed" - Creates perception of two-class care - Constant questions about "what's included in my tier" - Administrative nightmare tracking who gets what - A premium tier priced above $150/month costs those members their HSA eligibility (see the 2026 HSA box above)

Age-Bracketed Pricing (5+ age tiers)¶

Problems: - Patients "age into" higher prices (awkward conversations) - Complex to explain and remember - Minimal revenue benefit vs. simple adult/child split

Low Base + Fee-for-Everything¶

Problems: - Patients delay needed care to avoid costs - Undermines the "unlimited access" DPC appeal - Unpredictable revenue - Feels like traditional healthcare billing

The DPC Advantage is Simplicity: Patients are fleeing the complexity of insurance-based healthcare. Don't recreate that complexity in your pricing.

Checklist: Selecting Your Membership Model¶

• Calculate required revenue (see Pricing Your Practice)
• Choose your model: Individual/Family, Age-Based, or Annual + Per-Visit
• Set your rates based on local market research
• Determine family cap (at or below $300/month, and individual tiers at or below $150/month, if you want members to keep HSA eligibility)
• Define what's included vs. additional cost
• Decide on annual prepayment discount (typically 10%)
• Create simple one-page pricing sheet
• Draft membership agreement
• Practice your 30-second pricing explanation

Resources¶

• Pricing Your Practice - Calculate your specific pricing
• Membership Agreement Essentials - Document your model legally
• Employer Contracts Guide - Pricing for employer groups
• DPC Frontier Mapper - See other DPC practices and pricing
• IRS Notice 2026-05 - HSA rules for DPC arrangements

Read through and figures checked on 2026-09-22.

Next Steps¶

After selecting your model: 1. Pricing Your Practice - Run the numbers for your situation 2. Membership Agreement Essentials - Put it in writing