DPC vs. Traditional Insurance: A Real Cost Comparison for NC Residents

One of the most common questions I get from people who are curious about DPC is some version of: "Okay but is it actually worth it financially?" And I get it. Healthcare costs are already confusing enough. The last thing you want is to add another monthly bill without knowing if it makes sense for you.

So let's actually look at the numbers, specifically for people here in North Carolina, because our state has its own story when it comes to healthcare costs and it is not a pretty one.

First, the Bad News About NC

North Carolina is one of the most expensive states in the country for healthcare. According to a 2024 Forbes analysis, NC ranked number one for highest healthcare costs in the entire US. The average employee contribution for employer-sponsored single coverage here runs about $1,810 per year just in premiums, and that is before you have spent a single dollar on actual care. For families, employees are contributing an average of $8,839 out of pocket annually just for their share of premiums.

And if you are buying on the Marketplace? The benchmark silver plan in NC averages around $495 per month. That is nearly $6,000 a year before you have seen a doctor once.

On top of premiums, the average deductible for a single employer plan in NC is around $2,268. So in a year where you actually use your insurance, you could easily be looking at $4,000 or more out of pocket before your insurance covers much of anything. That is a tough reality for a lot of people.

What Does a Traditional Primary Care Visit Actually Cost?

This is where it gets frustrating, because the answer genuinely depends on where you are in your deductible. If you have not met your deductible yet, a standard primary care visit in NC can run you $100 to $300 out of pocket, since you are paying the full negotiated rate. Once you have met your deductible, you are typically looking at a copay of around $27 on average for primary care, though many plans run $40 to $50.

And then there are labs. If your doctor orders bloodwork and you have not hit your deductible, expect to pay significantly more than you might think. A basic comprehensive metabolic panel at a hospital outpatient lab can run $150 to $300. A full annual panel with multiple tests can easily reach several hundred dollars.

Compare that to what Staywell members actually pay at LabCorp. A comprehensive metabolic panel is $4. A CBC with differential is $3. A lipid panel is $4. A TSH is $4. The entire Staywell Health Order Set, which includes all of those plus a Hemoglobin A1c and Vitamin D, is included at no cost for Complete Membership members. Even for tests outside the standard panel, the member prices are a fraction of what most people pay through insurance. These are negotiated rates for Staywell members and are subject to change, but they give you a real sense of the difference.

Lab Test	Typical Cost Through Insurance (pre-deductible)	Staywell Self-Pay Rate
Comprehensive Metabolic Panel (CMP)	$40 - $150+	$4
CBC with Differential	$30 - $100+	$3
Lipid Panel	$50 - $150+	$4
Hemoglobin A1c	$30 - $100+	$3
TSH (Thyroid)	$50 - $200+	$4
Vitamin D	$50 - $250+	$15
Testosterone, Total	$50 - $200+	$10
HIV Ab with Reflex	$50 - $150+	$15
Full Annual Panel (Staywell Order Set)*	$200 - $600+	Included with Complete Membership

*Staywell Order Set includes CMP, CBC with differential, Lipid Panel, TSH, Vitamin D, and Hemoglobin A1c. Staywell prices reflect negotiated rates for Staywell Health members and are subject to change. Insurance cost estimates reflect typical pre-deductible patient responsibility and vary by plan and facility.

What Does a Staywell Membership Cost?

At Staywell, the Complete Membership runs $89 per month for individual adults, which works out to $1,068 per year. That covers all your visits (in-person and telehealth), your annual comprehensive lab panel, direct messaging with me, same-day or next-day access when you need it, and your annual wellness exam. No copays, no surprise bills. Couples are $169 per month, and you can add children under 25 for $39 each. There is also an Access Membership at $39 per month for adults 25 and older (or $29 for those under 25) that gives you provider access and discounted rates on a pay-as-you-go basis. Pricing listed here is as of the writing of this post and is subject to change. Visit the pricing page for current rates.

There are no copays when you come in. No surprise lab bills. No sitting on hold to ask a question.

Let's Run Some Real Scenarios

Numbers in a paragraph are hard to absorb, so let me just break down a few realistic situations.

Scenario 1: The Mostly Healthy Person

You are generally healthy. You want an annual wellness visit and some baseline labs done once a year. Maybe you get sick once or twice and need to be seen.

Expense	Traditional Insurance (with deductible)	Staywell DPC Membership
Annual premium contribution (employee share, NC avg)	~$1,810/yr	$1,068/yr (Complete) or $468/yr (Access)
Annual wellness visit	Often covered, but not always	Included in Complete membership
Annual lab panel	Sometimes covered, sometimes not; $50-$300+ if not	Included in Complete membership
2 sick visits	$54-$600 depending on deductible status	Included in Complete; $49 each with Access

Even just looking at premiums alone, the difference is significant. And that is before factoring in any copays or lab costs you might still owe on top of your premium.

Scenario 2: The Uninsured or Self-Employed Person

You do not have employer-sponsored insurance. You are buying on the Marketplace or going without. A bronze plan in Raleigh for a 40-year-old runs around $515 per month, with a deductible that can hit $7,950 before the plan pays anything meaningful for primary care.

Expense	Marketplace Bronze Plan	Staywell DPC + Catastrophic/Healthshare
Annual premium	~$6,180/yr	$1,068/yr membership + cost of catastrophic plan
Deductible before plan pays	Up to $7,950	N/A for primary care
Primary care visits	Full cost until deductible met	Included with Complete membership
Annual labs	Sometimes covered, sometimes not	Included with Complete membership

For a lot of people, paying $6,180 a year in premiums for coverage that does not kick in for everyday care until you have spent nearly $8,000 more out of pocket just does not add up. A Staywell membership paired with a lower-cost catastrophic or Healthshare plan for major medical can often be a more financially sustainable path.

Scenario 3: Managing a Chronic Condition

If you have something like diabetes, hypertension, or thyroid issues that require regular monitoring and follow-ups, the math shifts even more in favor of DPC. Each follow-up visit and each round of labs adds up fast in the traditional system.

Expense	Traditional Insurance (with deductible)	Staywell DPC Membership
4 follow-up visits per year	$108-$1,200+ depending on deductible status	Included in Complete membership
Quarterly labs (e.g. A1c, CMP)	$50-$300+ per draw depending on deductible status	$7 per draw (negotiated member rates)
Secure messaging between visits	Not typically available	Included
Same/next-day access when things change	Often weeks out	Included

More frequent touchpoints means better management, fewer complications, and less chance of ending up in a more expensive situation down the road.

What DPC Does Not Replace

I want to be straightforward here because I think it matters. DPC is not insurance. If you need a specialist, imaging, a hospital stay, or surgery, you are going to need some form of major medical coverage for that. DPC handles the primary care layer, and primary care is where the majority of people's everyday health needs actually live. But it is not everything.

The good news is that having a solid DPC relationship often reduces the need for downstream specialist visits, because more things get caught and managed early. That is not just a talking point. It is a real pattern we see in practices like this.

So Is It Worth It?

For most people, yes. Especially if you are self-employed, uninsured, underinsured with a high-deductible plan, or just tired of not being able to get in to see anyone when you actually need to. The math usually works out, and you get something the traditional system genuinely cannot give you: a provider who knows you, has time for you, and is reachable when you need them.

If you want to talk through what makes sense for your specific situation, that is exactly what the free meet and greet is for. No pressure at all.

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