Andrea Meneses discovered a direct primary care clinic during a family emergency. Her grandmother, who had traveled from Bolivia to Wisconsin, needed immediate medical attention but lacked insurance after a mishap with her insulin storage. In her search for a quick solution, Meneses consulted friends, and one of them recommended Dr. Wendy Molaska, who operates a direct primary care clinic in Madison. This type of clinic allows patients to pay a monthly fee—typically between $50 to $100—to receive direct and unrestricted access to their doctor without incurring additional charges.
The idea of direct primary care is gaining traction and is likely to become even more prevalent due to anticipated changes in healthcare policy under the Trump administration. During his recent confirmation hearings, Robert F. Kennedy Jr., the nominee for Secretary of Health and Human Services, mentioned the significance of direct primary care. Gayle Brekke, a health services researcher with extensive experience in this field, shared her optimism, citing a pivotal moment when direct primary care could potentially flourish.
Patients and physicians appreciate the streamlined process of obtaining routine medical care, which often translates to lower costs. However, public health experts warn against viewing direct primary care as a substitute for health insurance, as the monthly fee only covers office visits.
Many patients have reported substantial savings on healthcare costs through direct primary care, especially those who do not have insurance and would otherwise face high out-of-pocket expenses. In Meneses’ case, Dr. Molaska referred her grandmother’s insulin prescription to a partnered community pharmacy that provided it at a reduced price. Brekke also noted that direct primary care physicians often collaborate with labs and imaging centers to offer patients tests and X-rays at discounted rates. Additionally, these practitioners can dispense certain medications with minimal markup or work alongside local pharmacists to help patients secure affordable medications.
Dr. Molaska has set her fees between $70 and $85 for individual patients, with a cap of $200 for families. She caters to a diverse patient base in central Wisconsin, offering services in both Spanish and English, and has a waiting list of 125 individuals eager to receive care. After experiencing the effectiveness of this model, Meneses’ entire family chose to become patients of Dr. Molaska, benefiting from cheaper medications for her children and quicker appointment availability.
Direct primary care also allows physicians to dedicate more time to patient interactions and reduces burnout, largely because they are not entangled in the complexities of insurance claims. Meneses expressed her desire for more people to become aware of this model, noting that many of her clients from the Hispanic community do not qualify for healthcare assistance and struggle to afford traditional healthcare options.
Despite its benefits, critics argue that direct primary care is only a feasible solution for a small segment of the population, particularly healthier individuals, those unable to afford insurance, or residents in regions where community health centers are overwhelmed. Health researchers also caution against overstating the affordability of direct primary care. According to Dr. Stephanie Woolhandler, many patients face difficulties even with minor expenses like bus fare or co-payments.
While Dr. Kevin Schulman acknowledges that direct primary care is “better than nothing,” he emphasizes its limitations since it does not provide health insurance coverage — meaning any medical issues requiring specialist care or hospital treatment fall outside its scope. Dr. John Vanderloo, practicing in Mississippi—a state with high rates of poverty and chronic illnesses—asserts that while direct primary care may not address all healthcare needs, it offers essential support for manageable conditions like diabetes.
Health providers, including Florida’s Dr. Lee Gross, have opted for direct primary care after facing challenges with traditional insurance systems. Gross, who established his practice in 2010, sought to streamline patient care without intermediary complications. Long-term patient Annie Geisel appreciated the promptness and lack of co-payments at Gross’s clinic, contrasting it with the delays faced by friends dealing with insurance companies.
Growing dissatisfaction with conventional health insurance, highlighted by public grievances following the controversial leadership changes at large insurance companies, may position direct primary care as an appealing alternative. The Heritage Foundation’s Project 2025 endorses direct primary care as a viable solution, stating that it enhances access to care while fostering better doctor-patient relationships. Schulman mentioned that these discussions could influence Trump’s plans to alter healthcare accessibility, something he pursued in previous years but that did not materialize under the Biden administration.
As discussions of healthcare reform continue, direct primary care may become even more relevant, particularly if there are potential cuts to Medicaid that could restrict eligibility. Dr. Gross views direct primary care as a crucial lifeline for individuals navigating gaps in the healthcare system, predicting further growth and outreach of this model nationwide.
