Understanding How Primary Care Works with Medicare

Mar 22, 2022

Understanding How Primary Care Works with Medicare

Healthcare is one of the most important things that everyone has to consider. One popular traditional healthcare alternative that’s been on the rise in recent years is direct primary care (DPC). Direct primary care is a model in which patients pay a monthly or yearly fee for membership in practice instead of getting charged per treatment. Currently, traditional medical practices get paid by providing treatments that bill the insurance companies. The insurance companies reimburse the doctors when they provide care. This allows both the doctor and the patient to receive financial compensation for their work.  Direct primary care is different because it bypasses dealing with insurance providers entirely, and it allows both the doctor and patient to be paid upfront instead of waiting for insurance reimbursement. With that being said, it’s important to understand that Medicare is still important. 

Many patients who use the services of a direct primary care physician wonder whether or not to keep their Medicare plans. After all, if they drop their Medicare coverage, they won’t be able to use it toward their membership costs. But the truth is that Medicare can be very valuable. It’ll still cover costs outside of your direct primary care provider, and it will also cover medical expenses that are not related to your DPC membership. To help you better understand this, we’ve put together a brief discussion on this subject. If you want to learn more about this, read on as we discuss how primary care works with Medicare.

Medicare Covers Extra Services

Most primary care providers offer patients direct coverage of necessary primary care. If a patient needs any sort of labs, X-rays, or medications, the provider can work with Medicare to get those things covered.

Medical Insurance Is Required by the Law

The thing about Medicare is that it’s necessary in order to comply with federal law. This is because all patients should carry some form of medical insurance even if they decide to make use of DPC. All patients should have some sort of medical insurance, regardless of the care model used. Patients seeking DPC might choose a high-deductible plan, a major medical plan, or an HSA-compatible health care plan. Medicare will allow these plans to minimize costs while still complying with federal law.

Medicare Covers Recurring Medical Expenses

If you are on Medicare but opt to use DPC instead, you will still save money through your insurance. Medicare will cover most of the cost of your prescription medications, or other medications that your DPC physician prescribes for you. You are also protected from liability in the case that you need to see a specialist or have major medical services.


We hope this article proves to be useful when it comes to furthering your understanding of how Medicare works alongside direct primary care. As you can see, having medicare still has its uses even if you are utilizing DPC. While a direct primary care physician will not bill through your insurance, you still should have an insurance plan. If you have further questions, direct them to your chosen DPC provider. They will be able to help you better if they understand the specific details of your plan and your insurance details.

HealthSprings Direct specializes in direct primary care practice south of Atlanta. We deliver high-quality, convenient, and cutting-edge healthcare. Join the healthcare revolution—call us now!