How it works

Direct primary care, explained without the jargon

Most people have never heard the term, which is fair. It’s not really a new idea. It’s closer to the way medicine worked before insurance ran everything. Here’s how it works, including the question I get first: no, it isn’t meant to replace your insurance, and I’ll explain how the two fit together.

Become a member

What direct primary care is

Direct primary care, or DPC, is basically a membership model for your regular doctor. You pay the practice a flat monthly fee. In return your primary care comes with no copays, no insurance billing, and no clock running on the visit. Since I’m not billing insurance, I don’t need two thousand patients to keep the lights on. I keep a few hundred. That’s the whole reason the visits can run long and the prices stay simple.

It’s the same idea as the old small-town doctor who knew every family, just brought into now. A text you can send the same day. Telehealth when it saves you a drive. Lab prices you can actually see, instead of a bill you can’t read.

What you get

What you get as a member

  • Unlimited visits, no copays

    Come in as often as you actually need to. Each visit runs thirty to sixty minutes, not the seven you’re used to.

  • Same or next-day access

    When something’s wrong, you’re not left waiting three weeks for the next opening on a calendar.

  • My direct line

    You text, call, or email me directly, and for anything that can’t wait, I’m reachable in the evenings and on weekends.

  • Preventive and chronic care

    Your annual physical and preventive care, plus the ongoing management of things like blood pressure, diabetes, thyroid, and cholesterol.

  • In-office care

    Women’s and men’s health, plus the minor procedures I can do right here: skin checks, biopsies, joint injections, stitches.

  • Wholesale labs, imaging, and meds

    Passed to you at my cost, with no markup added on top.

  • Care coordination

    When you need a specialist, imaging, or the hospital, I set it up, send my notes, and follow up, so you’re not left to manage it alone.

  • Telehealth, included

    For the times a visit doesn’t really need to happen in person.

Add it all up and I handle roughly ninety percent of what people need primary care for, right here in the office.

This is not insurance

A membership isn’t health insurance, and it was never meant to replace it.

Almanac covers your primary care, both the day-to-day and the ongoing conditions. It doesn’t cover a hospital stay, surgery, the ER, a specialist, or advanced imaging. For those bigger, rarer things you keep some coverage, usually a high-deductible health plan or a health-sharing arrangement. Think of it as two separate jobs. My job is to be your doctor and keep you out of the expensive parts of the system when I can. Your coverage is there to catch the big stuff.

Most members pair Almanac with a lower-premium, higher-deductible plan and spend less in total, because the primary care that used to eat up their deductible is now a flat fee, at wholesale, with no copays. And when you do need the big system, I’m the one who coordinates it, so you’re not sorting out specialists and hospitals on your own.

You can absolutely keep the insurance you already have. I just don’t bill it. That’s what frees up the time.

How we keep it affordable: wholesale labs and medications

Because I’m not routing everything through insurance, I can pass my actual cost straight to you on labs, imaging, and a lot of medications. A few real examples:

  • Lipid panel~$6bills at $60 to $200 through insurance
  • A1c (the diabetes check)~$9
  • Complete metabolic panel~$8
  • CBC (complete blood count)~$4
  • Common generic medicationsA few dollarsfor a month’s supply, and some are pennies a dose
  • ImagingCash ratesoften a few hundred dollars for a scan that bills at a few thousand

No markup, and no surprise bill weeks later. You see the price before you agree to it.

Use your HSA

New for 2026

Use your HSA

Direct primary care memberships became HSA and FSA eligible on January 1, 2026, up to $150 a month for an individual and $300 a month for a family. If you have a health savings account paired with a high-deductible plan, you can pay your Almanac membership out of it, before tax. It’s part of why pairing a membership with a high-deductible plan adds up now.

Direct primary care vs concierge medicine

People mix these two up all the time, so here’s the difference.

Concierge medicine

Usually runs $2,000 to $5,000 or more a year. And here’s the part that usually gets left out: a concierge practice still bills your insurance for the actual care. The retainer just buys you access on top of the insurance system you already have.

Direct primary care

A fraction of that cost, and I don’t bill anyone. There’s no insurance involved at all, which is why the price can be this low. And the 2026 HSA rule applies to direct primary care memberships, not to concierge fees.

Bottom line, it costs a lot less and there’s no insurance in the middle of it.

How to join

Three steps, and the first one is free

  1. 1

    Meet me first

    A free twenty-minute visit, in person or over the phone. No forms, and no pressure to decide anything.

  2. 2

    Enroll, month-to-month

    You pay a one-time enrollment fee and your first month. No contract. We sit down and do it together, in person.

  3. 3

    Start getting care

    You get my cell number the day you join, and you book your first real visit whenever you need it.

Questions

Frequently asked questions

Is this health insurance?
No, it’s a membership for your primary care. You keep a high-deductible plan or a health share for the hospital, the ER, surgery, and specialists. I take care of the day-to-day, and your coverage is there for the big, rare things.
Can I keep my current insurance?
Yes. I just don’t bill it. A lot of members do end up switching to a lower-premium, higher-deductible plan once the membership is covering their primary care, but that’s your call. I don’t require it.
What if I need a specialist or the hospital?
You use your coverage for that, and I handle the coordinating. I refer you, send over my notes, talk to the specialist, and follow up afterward so nothing falls through the cracks. That coordination is part of your membership.
What does it cost?
Every price is published on the Membership and Pricing page. Most adults are $75 to $110 a month depending on age, kids are $30, and no household pays more than $250 a month, however big the family is.
Is there a contract?
No, it’s month-to-month. If it stops being worth it, cancel with thirty days’ notice. There’s no penalty on the way out.
Is there a sign-up fee?
Yes, a one-time enrollment fee of $75 per adult, and nothing for children. That’s it.
Do you take Medicare or Medicaid?
I don’t bill Medicare, Medicaid, or any insurance for the membership. Medicare patients are still welcome. You keep Medicare for the hospital, the specialists, and anything outside primary care, and you pay the flat membership for the care I give you. If you’re on Medicaid, reach out and we’ll talk it through honestly before you join.
What about my prescriptions?
I keep a lot of common generics right here and dispense them at wholesale, often a few dollars a month. For anything I don’t stock, I send it to your pharmacy the way any doctor would. Membership doesn’t make medications free, but it usually makes the common ones a good deal cheaper.
How fast can I actually be seen?
Same or next-day for most things. And honestly, a lot of what comes up can be handled with a text or a photo, so you don’t have to come in at all.
How do I reach you?
Once you’re a member, you have my cell number, and you text, call, or email me directly. You’re not routed through a call center or a portal to reach your own doctor.
Can my employer pay for this?
Yes. More than half of DPC memberships in the country now work exactly that way. If you run a small business, take a look at the For Employers section on the Membership page.

Still have questions? Come ask me in person. That visit is free.

A free twenty-minute meet-and-greet, in person or over the phone. No health forms, and no pressure.

Meet Dr. MarshOr become a member