Medicare beneficiaries spend an average of $6,330 out of pocket annually — 39% of Social Security income. Here's how Direct Primary Care works alongside Medicare to give Prescott retirees better access, longer visits, and predictable costs.
If you're a retiree in Prescott — and statistically, there's a strong chance you are, given our median age of 60.3 — you probably have Medicare. And you probably have questions about whether Direct Primary Care works with it.
The short answer: yes, and it may be one of the smartest healthcare decisions you make in retirement. But the details matter, and there's a lot of confusion out there. Let's clear it up with actual data.
Here's a number that frames the conversation: KFF research (2025) found that Medicare beneficiaries spend an average of $6,330 out of pocket on healthcare annually — consuming 39% of their average Social Security income. One in four beneficiaries spends more than 21% of their total income on health costs.
Despite paying for Medicare through decades of payroll taxes and monthly premiums, retirees are still spending thousands each year. Understanding where DPC fits into that picture can help you get better care while making those dollars more predictable.
Key Takeaways
- Medicare beneficiaries spend $6,330/year out of pocket — 39% of Social Security income (KFF, 2025)
- DPC provides 30-60 min visits vs. 15-20 min in traditional Medicare primary care
- Medicare Advantage satisfaction dropped 29 points year-over-year (J.D. Power, 2025)
- Starting 2026, HSA funds can cover DPC memberships up to $150/month
How Does DPC Work Alongside Medicare?
This is the most common question I hear from Prescott retirees, and it's the most important one to answer clearly. DPC does not replace Medicare. It works beside it.
Here's how the model works: you keep your Original Medicare (Parts A and B) or pair it with a Medigap supplemental plan. Medicare continues covering hospitalizations, specialist visits, imaging, surgeries, and emergency care — everything it covers today.
Separately, you pay a DPC membership fee ($135/month at our practice for adults 65+) that covers all of your primary care. Unlimited office visits. Same-day appointments. Telemedicine. Direct access to Dr. Price by phone, text, or email. Same-day lab result calls. No co-pays. No per-visit charges.
We don't bill Medicare for your primary care visits. That's the structural difference. By stepping outside the insurance billing system for primary care, we eliminate the administrative overhead that forces traditional practices to see 25+ patients per day in 15-minute slots.
Why Is Medicare Advantage Satisfaction Dropping?
If you're currently on a Medicare Advantage (MA) plan, you're not alone — about half of all Medicare beneficiaries now choose MA over Original Medicare. But satisfaction is trending the wrong direction.
The J.D. Power 2025 U.S. Medicare Advantage Study found that overall MA customer satisfaction scored 623 out of 1,000 — down 29 points year-over-year. Trust in MA plans dropped 39 points. Only 38% of first-year MA members said their insurer fulfilled service expectations.
On the provider side, the picture is equally concerning: 19% of health systems have stopped accepting at least one MA plan, and another 61% are planning to do so. When your plan's network shrinks, your access to care shrinks with it.
I hear this from Prescott patients frequently: "My Medicare Advantage plan looked great on paper — low premiums, dental included, gym membership. But when I actually needed to see a specialist, I waited six weeks. When I needed a procedure, it required prior authorization that took three more weeks. The coverage was broad, but the access was narrow." DPC solves the access problem for primary care — the type of care you use most.
What Does Medicare Actually Spend on Your Primary Care?
Here's a statistic that surprises most people: Medicare spends only 3.4% of its total budget on primary care, according to the Milbank Memorial Fund's 2025 Primary Care Scorecard. Across all U.S. healthcare spending, primary care accounts for less than 5%.
That 3.4% is supposed to cover the care that manages your chronic conditions, catches problems early, coordinates your specialists, and keeps you out of the hospital. It's the foundation of your health — funded at less than a twentieth of total spending.
The result is predictable: Medicare physician payments have declined 33% since 2001 when adjusted for practice cost inflation. The 2025 Medicare Physician Fee Schedule includes another 2.83% cut. Physicians seeing Medicare patients are being asked to do more with less every year — and the quality of the visit suffers.
This is the fundamental tension that DPC resolves. When primary care is funded at 3.4% of the total, the system optimizes for volume — more patients, shorter visits, faster throughput. DPC reverses that equation by funding primary care directly through membership, at a level that supports 30-60 minute visits with a physician who manages 413 patients instead of 2,500.
Only 25% of Medicare Beneficiaries Get Their Annual Wellness Visit
Medicare covers a free Annual Wellness Visit — no copay, no deductible. It's one of the most valuable preventive benefits in the program. And research published in Annals of Family Medicine (2024) found that only about 25% of eligible Medicare beneficiaries actually use it.
Why? Partly because getting an appointment takes an average of 23.5 days for family medicine (AAFP/AMN Healthcare, 2025). Partly because the traditional 15-minute visit doesn't leave time for a thorough wellness assessment. And partly because many beneficiaries don't even know the benefit exists.
In DPC, preventive care isn't a separate annual event you have to remember to schedule. It's woven into every visit. When Dr. Price sees you for a sore knee, she's also checking your blood pressure, asking about your sleep, noticing changes since your last visit. Prevention happens continuously — not once a year if you remember to book it.
The Cost Math: DPC Membership + Medicare
Let's run the numbers for a Prescott retiree:
- DPC membership: $135/month ($1,620/year) — covers all primary care, unlimited visits, telemedicine, direct access
- Original Medicare Part B premium: ~$185/month ($2,220/year) — covers 80% of specialist visits, imaging, outpatient services
- Optional Medigap Plan G: ~$150-200/month — covers the 20% that Part B doesn't
Total annual cost: approximately $5,400-6,240 for comprehensive coverage with no primary care copays, same-day access, and full specialist/hospital coverage.
Compare that to the KFF average of $6,330 in out-of-pocket spending for traditional Medicare beneficiaries — which includes copays, coinsurance, deductibles, and prescription costs that add up unpredictably throughout the year.
DPC doesn't necessarily cost less in total dollars. But it delivers dramatically more primary care access for a predictable, fixed cost — and the research consistently shows that better primary care access reduces downstream spending on ER visits, hospitalizations, and specialist care.
The 2026 HSA Rule Change: DPC Just Got More Accessible
Starting January 1, 2026, a new IRS rule allows Health Savings Account (HSA) funds to be used to pay for DPC memberships up to $150/month. At $135/month for adults 65+, Prescott Professional Healthcare's membership falls within that limit.
If you have an HSA — or if you're considering pairing a high-deductible plan with an HSA before age 65 — this rule change makes DPC membership a tax-advantaged healthcare expense. It's a meaningful policy shift that recognizes DPC as a legitimate primary care model.
What DPC Can't Do (And Why You Still Need Medicare)
Transparency matters. Here's what DPC membership does not cover:
- Hospitalizations. If you need surgery, an ER visit, or inpatient care, that's Medicare's domain.
- Specialist visits. If Dr. Price refers you to a cardiologist, rheumatologist, or orthopedic surgeon, those visits are billed through your Medicare coverage.
- Prescription drug coverage. Medicare Part D or an MA plan with drug coverage handles your pharmacy costs. DPC helps you find the most affordable medication options, but doesn't cover the cost of the drugs themselves.
- Imaging and advanced diagnostics. MRIs, CT scans, and advanced testing go through Medicare. We order labs at wholesale prices when possible, but major imaging is a Medicare-covered service.
DPC replaces your primary care relationship — not your safety net. The two together give you the best of both worlds: personalized, accessible primary care plus the catastrophic and specialist coverage that Medicare provides.
In my experience with Prescott retirees who pair DPC with Original Medicare and a Medigap supplement, the most common feedback is about peace of mind. They know their primary care is covered without copays or visit limits. They know they can reach me directly when something comes up. And they know that if something serious happens, Medicare and their supplement handle the heavy lifting. That combination — accessible primary care plus comprehensive backup coverage — is what healthcare should feel like in retirement.
Is DPC Right for You?
DPC isn't for everyone. If you're healthy, rarely see a doctor, and are satisfied with your current Medicare Advantage plan's access and wait times — your current setup may be working fine.
But if you've experienced the 4-week wait for a routine appointment... if your visits feel rushed and impersonal... if you're managing chronic conditions that need more than 15 minutes of attention... or if you simply want a physician who knows you and is available when you need her — DPC alongside Medicare is worth a serious look.
At Prescott Professional Healthcare, we're happy to walk you through how DPC would work with your specific Medicare situation. No pressure, no sales pitch — just information so you can make an informed choice.
Enroll as a member or contact us at 928-515-2803. We'll answer every question you have — and we won't need to rush.
Frequently Asked Questions
Can I use Medicare and DPC at the same time?
Yes. You keep Original Medicare (Parts A and B) or a Medigap supplement for hospitalizations, specialist visits, and emergencies. Your DPC membership covers primary care separately — unlimited visits, same-day access, and direct physician contact — without billing Medicare. The two work alongside each other, not in competition.
Does Medicare pay for DPC membership?
No. Medicare does not reimburse DPC membership fees. However, starting January 1, 2026, HSA funds can be used to pay up to $150/month for DPC memberships under new IRS rules. At $135/month for adults 65+, Prescott Professional Healthcare's membership falls within that limit.
Is DPC compatible with Medicare Advantage plans?
Generally no. Medicare Advantage plans require you to use in-network providers and may not cover care received outside their network — including DPC visits. If you're considering DPC, Original Medicare with a Medigap supplement is typically the best pairing. We can help you understand the options during your first visit.
How much do Medicare beneficiaries spend out of pocket?
An average of $6,330 per year, according to KFF (2025). That amounts to 39% of average Social Security income. One in four beneficiaries spends more than 21% of their total income on healthcare. DPC's predictable $135/month membership eliminates co-pays and surprise primary care costs.
Why are doctors leaving Medicare?
Medicare physician payments have declined 33% since 2001 when adjusted for practice cost inflation (AMA data). The 2025 Medicare Physician Fee Schedule includes a 2.83% cut. While 98% of physicians still accept Medicare, 19% of health systems have dropped at least one Medicare Advantage plan, with 61% planning to follow.