Most healthcare spending happens before insurance helps. Even when you’re insured, it’s common to pay thousands of dollars out of pocket, especially on high-deductible plans, before coverage meaningfully kicks in. That’s why so many people delay care, avoid follow-ups, or feel like insurance isn’t doing much when they actually need it.

*If you’re reviewing your healthcare setup this January, this is one of the most important things to understand.*

If you’re actively weighing your options, we’ve put together a guide to help you compare health plans during Open Enrollment and see where Direct Primary Care fits into the bigger picture.

How Much You Pay for Healthcare Before Your Deductible Is Met

For many insurance plans, routine care is largely paid out of pocket until the deductible is met. That often includes:

Primary care visits
Lab work
Medications
Imaging
Follow-up appointments

During this period, you may be paying full or near-full prices, even while paying monthly premiums.

With deductibles commonly reaching several thousand dollars, most everyday healthcare expenses happen long before insurance starts sharing the cost.

Why Insurance Often Doesn’t Help With Everyday Healthcare Costs

Insurance is designed to manage financial risk, not to make routine care simple.

For day-to-day healthcare, insurance often adds:

Copays and coinsurance
Network restrictions
Prior authorizations
Insurance-driven pricing that inflates costs

As a result, many people end up paying more for the care they use most often, while still carrying insurance for emergencies.

How Direct Primary Care Reduces Out-of-Pocket Costs

Direct Primary Care (DPC) operates outside the insurance billing system.

Instead of charging per visit, DPC uses a flat monthly fee that typically includes:

Unlimited primary care visits
Same- or next-day appointments
Urgent care needs
Chronic condition support
Many in-office procedures

For most people, this covers the majority of the healthcare they actually use throughout the year, without copays or deductibles at the point of care.

Across the state, rising premiums and access issues are pushing people to look for alternatives. You can read more about why more New Yorkers are switching to Direct Primary Care and how this model is changing primary care access.

Why Labs, Medications, and Imaging Often Cost Less Without Insurance

A major driver of high healthcare costs is insurance-based pricing, not the care itself.

When services are accessed outside the insurance system:

**Lab work** is often available at a fraction of typical insurance prices
**Many medications** cost less at cash prices than insurance rates
**Imaging** at independent centers is frequently less expensive than hospital-based imaging

For people with high deductibles, these differences add up quickly, because every dollar spent early in the year comes directly out of pocket.

Do You Still Need Insurance If You Have Direct Primary Care?

For many people, yes, but for a different role.

Insurance is often most useful for major, unexpected medical events. Direct Primary Care is commonly used for routine and ongoing healthcare needs.

This setup allows everyday care to stay simple and predictable, while insurance remains in place for larger risks, instead of routing every healthcare decision through the insurance system.

Can You Use an HSA for Direct Primary Care?

Health Savings Accounts (HSAs) allow people to set aside pre-tax money for healthcare expenses, with balances that roll over year to year.

Current guidelines allow HSA funds to be used toward Direct Primary Care memberships (within set limits), making it easier to:

Budget for routine healthcare
Reduce surprise medical bills
Maintain consistent access to a primary care provider

For many people, this adds another layer of predictability to healthcare spending.

A More Practical Healthcare Setup for Individuals and Families

For many individuals, families, and small businesses, a more practical healthcare approach includes:

Predictable access to primary care
Lower costs for routine services
Insurance reserved for major medical events

At Homesteady Health, we provide Direct Primary Care in the Ithaca and Trumansburg area, helping patients simplify access to care and avoid unnecessary insurance-driven costs.

If you’re reviewing your healthcare setup and want a clearer understanding of your options, we’re happy to talk through it, without pressure or insurance jargon.

Call 607-882-6001 to schedule a quick chat about how Direct Primary Care can fit your needs.

Or contact us via email

Why Healthcare Costs So Much Before Insurance Covers Anything (Deductibles, Labs, and Primary Care)