$5,000 a Year Is Direct Care's "Bottom Row." Patients Should Hope It Stays There.

Every market eventually gets a map drawn by the people who sell its businesses. Direct primary care just got ours.

In October, the health care advisory firm Vector Medical Group and the law firm Baker Donelson published a white paper called State of Concierge and Consumer Medicine, 2026. It sorts membership medicine into 4 tiers by annual fee. Direct primary care sits on the bottom row, labeled "Standard/DPC": under roughly $5,000 a year, with 400 to 600 or more members per physician.

The tier above it, $5,000 to $15,000 a year with 150 to 400 members per doctor, is "where most sponsor-backed platform formation is concentrated," the paper says. Translated: that's where the investment money is going. One platform in the paper's tables charges a $30,000 base fee per member each year.

The authors advise on deals, and they say what deal people value out loud. In membership medicine, they write, the asset "is a renewing relationship." Value gets built with add-ons that "raise revenue per member without raising panel size": diagnostics, hormone optimization, weight management, wellness, aesthetics.

I don't fault anyone for reading a market that way. It's their job. But read that sentence again as a patient. A renewing relationship is an asset. Your trust is the thing on the balance sheet.

Here's what the bottom row actually looks like. The American Academy of Family Physicians puts typical direct primary care fees at $50 to $100 a month. That's $600 to $1,200 a year, a long way under $5,000. For that, a patient gets a doctor's cell number, same- or next-day visits, and labs and generic medications at prices you can see before you agree to them.

That's not the cheap seat. That's the design.

The paper calls the bottom tier the "broadest addressable market." I'd put it more plainly. It's where the plumbers, teachers, farmers, and small-business owners are. It's the carpenter with a $7,000 deductible and the travel nurse who couldn't afford his agency's plan. They don't need hormone optimization. They need someone to look at the rash, refill the blood pressure pill, and answer the text at 9 p.m.

There's a practical line, too. Since January, a qualifying direct care membership can be paid with HSA money without closing the account to new contributions, as long as it's primary care only and the fee stays at or under $150 a month for one person. Climb past that and members can still spend from the HSA, but they lose the ability to keep adding to it. Under the new federal rules, the bottom row is the only row that fits.

The paper says one more thing worth repeating: "Cash-pay does not mean unregulated." Good. Patients deserve that protection, and honest practices welcome it.

So let the capital build the $15,000 tier. Somebody will buy it. Direct care was never supposed to be a luxury good with a stethoscope. It was supposed to make the front door of medicine affordable enough that people walk through it early, while the problem is still small.

If you're choosing a membership this fall, ask 3 questions the deal teams ask, from the other side of the table. What does it cost each month, all in? What's included without an add-on? And who owns the practice: the doctor, or a fund that needs the fee to rise?

The bottom row is where most of America lives. It's the best place in medicine to practice.