Does Direct Primary Care Work With Medicare?

Direct primary care and Medicare can coexist, but the fit depends on two things: whether the doctor has opted out of Medicare, and which kind of Medicare coverage you carry. Get either one wrong and you can end up paying twice or losing access to the specialists Medicare is supposed to cover.

Why most DPC doctors opt out

Medicare rules prevent a physician who participates in Medicare from charging a Medicare beneficiary a membership fee for services Medicare covers. To run a DPC model legally, most DPC physicians formally opt out of Medicare by filing an affidavit with CMS. The DPC Alliance's 2026 survey found that about 81% of DPC physicians have fully opted out. CMS publishes the list of opted-out providers, which is a quick way to check any doctor's status.

The private contract

When you join an opted-out practice you sign a private contract. It states that the physician will not bill Medicare, that you will pay the membership yourself, and that Medicare will not reimburse you for those fees. It applies only to that physician's services. Everything the practice orders elsewhere, such as hospital care, specialist visits, outside labs, imaging and prescriptions, is still billed to Medicare in the normal way. Florida Direct Primary Care in St. Augustine describes exactly this arrangement on its site: Medicare patients sign a waiver, and Medicare still covers external medications, labs, imaging and referrals.

Original Medicare versus Medicare Advantage

The pairing works most cleanly with Original Medicare (Parts A and B) plus a Medicare Supplement. Original Medicare does not require referrals, so seeing a DPC doctor who is outside Medicare creates no gatekeeping problem, and the Supplement continues to cover the coinsurance on Medicare-covered services elsewhere.

HMO-style Medicare Advantage plans are a different matter. They require an in-network primary care physician to manage referrals, and an opted-out DPC doctor cannot fill that role. Members end up either maintaining a second in-network PCP purely to write referrals, or losing access to specialists the plan would otherwise cover. Florida Direct Primary Care says plainly that HMO Medicare Advantage plans "do not work well" with the model, and Balanced Physician Care accepts Original Medicare but not Medicare Advantage for that reason. PPO Advantage plans sit in between, since they allow out-of-network care at a higher cost.

What to keep and what to drop

Keep Part B. Keep your Supplement or Advantage plan. Keep Part D or a plan with drug coverage. The only thing a DPC membership replaces is your relationship with an insurance-billed primary care office. Dropping Part B to save the premium would leave you without coverage for outpatient care and would add a permanent 10% penalty for every 12 months you went without it if you ever re-enrolled.

Is it worth the extra monthly fee?

For a Medicare beneficiary the membership is an out-of-pocket cost on top of premiums you are already paying, so the question is value rather than savings. People who choose it are usually paying for time: 30-minute visits, same-day access, a doctor who answers the phone, and someone to coordinate the specialists. Practices in this directory that welcome Medicare-age patients price it between $100 and $150 a month. A coverage partner who is a Certified Medicare Insurance Planner can tell you whether your current Advantage plan will fight the arrangement and, if so, what it would take to move to a Supplement during a window when you can.