You have probably seen the pitch: pay your doctor a flat monthly fee, skip the copays and get an appointment this week. The model is called direct primary care, and Colorado has had rules for it since 2017. Two things make this fall a sensible time to understand it. A federal change that took effect on Jan. 1, 2026 lets many members pair a membership with a health savings account, and open enrollment for 2027 health plans starts Nov. 1.
What direct primary care is
In direct primary care, usually shortened to DPC, a patient pays a practice a flat monthly or annual membership fee for a defined set of primary care services, and the practice does not bill insurance visit by visit. That is how a February 2026 report from Colorado’s Primary Care Payment Reform Collaborative, posted by the state Division of Insurance, describes the model. The same report counts roughly 144 DPC practices in Colorado as of December 2025. The American Academy of Family Physicians says the fee typically covers all or most primary care services, including clinical and laboratory services, consultations, care coordination and comprehensive care management, and its patient site puts the usual price for adults at $50 to $100 a month.
What Colorado law says: it is not insurance
Colorado House Bill 17-1115, signed on April 24, 2017 and in effect since Aug. 9, 2017, added Article 23 to Title 6 of the state statutes. Its core sentence is short: direct primary care is not insurance and is not regulated by the commissioner of insurance. In exchange, the law spells out what a written direct primary care agreement has to do. It must:
- Describe the primary care services the periodic fee pays for.
- Specify the periodic fee and any additional fees that may be charged.
- Bar the provider from sending a fee-for-service claim to a health insurer for services the agreement covers.
- Disclose, conspicuously and prominently, that the agreement is not health insurance, does not meet any individual health plan mandate under federal law, and does not carry the consumer protections of the state insurance code.
- Allow either side to end the agreement in writing, with notice, under the refund terms the agreement sets out.
What a membership covers, and what it does not
The fee buys primary care: office visits, physicals, help managing chronic conditions and, usually, a direct line to your doctor. It does not buy hospital stays, surgery, emergency care or specialist visits. The family physicians’ patient site says it plainly: a membership is not insurance, and you should have insurance for the services DPC does not offer, such as emergency room or hospital care. It adds that prescriptions, some lab tests and some procedures may not be fully covered by the fee.
Here is what that looks like at one local practice. Ridgeview Direct Care, a Wheat Ridge practice led by Dr. Christopher Kroner, a family practice and sports medicine physician, posts its prices: $99 a month for an individual at its founding-member rate ($129 standard) and $179 for two adults ($199 standard), plus $39 a month for each child up to age 26 and a one-time registration fee. Its primary care membership page lists office visits, preventive care and physicals, acute illness and injury, chronic disease management and sports medicine consultations as included, with labs and medications billed separately at or near wholesale and some procedures at an added cost. The practice’s own explainer on how direct primary care and health insurance work together makes the same point the statute does: a membership does not replace insurance.
The 2026 change: pairing DPC with an HSA
The biggest recent change is federal. The IRS says that beginning Jan. 1, 2026, an otherwise eligible person enrolled in certain direct primary care arrangements may contribute to a health savings account and may use HSA money tax-free to pay the periodic fees. IRS Notice 2026-5 sets the boundaries:
- The fee cap is $150 a month for an individual, or $300 a month for an arrangement that covers more than one person. The IRS kept the same figures for 2027.
- The arrangement must provide only primary care, paid for by a fixed periodic fee. Procedures that require general anesthesia, prescription drugs other than vaccines, and lab services not typically done in a primary care office fall outside the definition.
- You still need HSA-eligible coverage. As of 2026, bronze and catastrophic plans count, along with traditional high-deductible plans.
- HSA contribution limits are $4,400 for self-only coverage and $8,750 for family coverage in 2026, rising to $4,500 and $9,000 in 2027. People 55 and older can add $1,000.
Two cautions. If your fees exceed the cap, the notice says the arrangement disqualifies you from making HSA contributions for as long as you are enrolled. And the IRS says whether an arrangement qualifies depends on its terms, not only its price, so a practice that bills some items outside the monthly fee is worth a careful look. Ask the practice, then confirm with your plan administrator or a tax professional before you count on the deduction.
If you have Medicaid or Medicare
Health First Colorado members should read the state’s policy statement first. Colorado law says members cannot be billed for services Medicaid covers, and the Department of Health Care Policy and Financing notes that most services offered under a DPC model are covered ones. A practice may offer members only a limited package of services Medicaid does not cover, under a documented written agreement. On Medicare, the HSA side is simple: the IRS says your contribution limit drops to zero starting the month you enroll.
Questions to ask before you sign
- Which services does the monthly fee include, and which cost extra? Ask for the price list for labs, medications and procedures.
- How do I cancel, how much notice is required, and what is refunded?
- What happens when I need a specialist, imaging or a hospital, and how does the practice work with my insurance?
- Does the fee fit under the federal HSA cap, and is anything billed outside the periodic fee?
Why now: open enrollment
Connect for Health Colorado’s open enrollment for 2027 coverage runs from Nov. 1, 2026 through Jan. 15, 2027; enroll by Dec. 15 for coverage that starts Jan. 1. The marketplace says all of its bronze and catastrophic plans are now HSA-eligible; catastrophic plans are available to people under 30. Whether pairing a membership with one of those plans saves money depends on your premiums and how often you see a doctor, so run your own numbers first.
Sources
- Colorado General Assembly, HB17-1115, Direct Primary Health Care Services, and Colorado Revised Statutes 6-23-101 to 6-23-105 (2025 text).
- IRS news release IR-2025-119, Notice 2026-5, Rev. Proc. 2026-24 and Publication 969.
- Connect for Health Colorado, What’s New (open enrollment dates) and Types of Health Plans.
- Colorado Department of Health Care Policy and Financing, policy statement on billing Health First Colorado members.
- Colorado Primary Care Payment Reform Collaborative, Seventh Annual Recommendations Report (February 2026).
- American Academy of Family Physicians: Direct primary care: What to know and familydoctor.org.
Disclosure: Ridgeview Direct Care is a Holland Health Marketing client. Read Ridgeview Direct Care’s Colorado Local profile.
For how the HSA rules apply to your own plan, check with your plan administrator or a tax professional. This is general information, not medical advice.
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