You keep your insurance. We work alongside it.
Whether you have a PPO, an HMO, a high-deductible plan, Medicare, or no insurance at all, Simplicity Health fits your situation. Here's exactly how, and what changes (and doesn't) when you become a member.
Think of health insurance like car insurance.
You don't use car insurance for oil changes or new tires. You carry it for the unexpected and catastrophic. The same logic applies to your health, and it's why Simplicity Health members keep their insurance and pay less overall.
Your Car
Your Health
When we lower the price of labs, medications, and imaging by 90 to 95%, everyday healthcare becomes affordable on its own. Your insurance is free to do what insurance is supposed to do, which is protect you from the catastrophic.
Which one describes you?
Most of our members fit one of the four situations below. Here's how membership works in each, and what to expect.
I have a PPO or HMO through my employer.
Good news. Over 80% of our members do too, and they still choose Simplicity Health for what insurance can't deliver.
- Nothing happens to your existing insurance when you join.
- We compare cash prices to your insurance copay and recommend whichever is cheaper.
- We routinely save highly-insured patients hundreds (sometimes over $1,000) on labs, medications, and imaging.
- Members come for what insurance won't pay for: longer visits, the same doctor every time, and direct cell phone access.
I have a high-deductible health plan.
Simplicity Health was built for you. Most HDHP members spend less overall once they're enrolled.
- You probably won't hit your deductible most years. Everything you pay toward it is out of pocket anyway.
- Our cash prices on labs and meds are dramatically below what insurance bills toward your deductible.
- HSA dollars cover your Simplicity Health membership, thanks to recent federal legislation.
- If you do hit your deductible in a tough year, your insurance kicks in for everything after — exactly as designed.
I'm on Medicare.
We accept Medicare patients. Membership runs alongside Medicare, not instead of it.
- You keep Medicare for hospital care, specialists, imaging, and prescriptions filled outside our office.
- You add Simplicity for unhurried visits, direct cell phone access, and personalized care coordination.
- Our physicians have specific expertise caring for patients over 65, including house calls when needed.
- The membership fee is a separate, non-reimbursable expense (Medicare does not cover it). Most of our Medicare members consider it well worth the cost.
I'm uninsured.
No insurance, no problem. Our model was designed for exactly this situation.
- We don't bill insurance for office visits, labs, or imaging — pricing is transparent and the same for everyone.
- Our in-house pharmacy fills most common medications at a fraction of retail.
- For care outside our scope (hospitals, specialists, major imaging), we'll help you navigate cash-pay options.
- Many uninsured members pair Simplicity with a health share plan like Zion, Altrua, or Sedera for catastrophic coverage.
What stays with your insurance. What moves to Simplicity Health.
The clearest way to understand the relationship: your insurance keeps doing what it's good at, and Simplicity takes over the everyday primary care it was never built for.
What you still use insurance for.
- Hospital stays and inpatient care
- Emergency room visits
- Surgeries and operations
- Specialist consultations and procedures
- Major imaging beyond what we negotiate (e.g., complex MRI, PET scans)
- Specialty medications filled at outside pharmacies
- Catastrophic and unexpected events
What your membership covers.
- Office visits (extended, never rushed)
- In-house labs at 80–95% below typical billed rates
- In-house pharmacy for most common medications
- Negotiated cash imaging (MRI, CT, ultrasound)
- Chronic disease management
- In-office procedures
- Direct cell phone access (Platinum and Diamond tiers)
- Care coordination and specialist referrals
One avoidable ER visit pays for years of membership.
It's 11 PM on a Saturday and you suddenly feel dizzy. Could it be a stroke? Vertigo? An inner ear issue? You need someone who knows you to weigh in. Here's how the same situation unfolds with and without a Simplicity Health membership.
A trip to the emergency room.
You drive to the ER because there's no one else to call. You wait. You're seen by a stranger who has none of your history. You get a workup that may or may not be necessary, then a bill arrives weeks later.
$2,500 – $5,000+A phone call to your doctor.
You text or call your physician, who knows your full history. They triage on the spot, reassure you when appropriate, or send you to the ER when it's truly needed. Most of the time, the ER trip is avoided entirely.
Included in membershipMembers on our Platinum and Diamond tiers receive VIP cell phone access for exactly this kind of moment. One avoided ER visit pays for multiple years of membership.
HSAs, FSAs, and health share plans.
Most members are surprised by how many ways there are to pay for the membership using money they already have set aside, or to pair it with catastrophic coverage outside the traditional insurance system.
Health Savings Accounts
Recent federal legislation made HSA funds eligible for Direct Primary Care memberships. All four Simplicity Health tiers can be paid with HSA dollars. Bring your specific plan details to your meet and greet and we'll walk you through it.
Flexible Spending Accounts
FSA eligibility depends on your plan administrator. Some allow DPC memberships; others don't. Bring your plan documents to your meet and greet and we'll help you confirm what's covered.
Health Sharing Plans
Plans like Zion Health, Altrua, and Sedera pair well with DPC. Some even offer discounts for members who have a DPC physician.
What people ask about insurance.
Should I cancel my insurance if I join Simplicity Health?
No. We recommend you keep it. Simplicity replaces (or supplements) your everyday primary care, but you still need insurance for hospitals, specialists, surgeries, ER visits, and other catastrophic events. The two work together — they don't replace each other.
Will my insurance change at all when I become a member?
No. Nothing about your insurance changes when you join Simplicity. Your premiums, deductibles, network access, prescription coverage, and everything else continue exactly as they were. We simply operate outside of insurance for the care we provide directly.
Can I still use my insurance for labs or medications?
Yes, whenever it's cheaper for you. We compare our cash prices to what insurance would charge, and we recommend whichever costs less. Many members are surprised that our cash prices for routine labs and generic medications often beat what insurance bills them, even after factoring in their copays.
Does Medicare cover the membership fee?
No. The Simplicity Health membership is a separate, non-reimbursable expense in addition to Medicare. You continue to use Medicare for hospital care, specialists, imaging outside our office, and prescriptions filled at outside pharmacies. Most of our Medicare members find the unhurried visits, direct access, and personal coordination well worth the additional cost.
What if I'm completely uninsured?
Many of our members are. Our model was built for transparent, predictable pricing without insurance. You'll know what everything costs before it happens. For events outside our scope — hospitals, ER, specialists — we'll help you navigate cash-pay options, and many uninsured members pair Simplicity with a health share plan for catastrophic coverage.
Can I really save money even with great insurance?
Often, yes. Even on excellent plans, copays and deductible payments stack up. Our cash prices on labs and medications routinely beat insurance pricing, and we always show you both options before you choose. Members frequently tell us they save hundreds per year on labs and medications alone, on top of the value of unhurried care.
What about HSAs and FSAs?
HSA funds can be used to pay for your Simplicity membership at every tier, thanks to recent federal legislation. FSA eligibility depends on your individual plan administrator — some allow DPC, others don't. Bring your plan details to your free meet and greet and we'll help you confirm what works.
Bring your plan to the meet and greet.
The free 20-minute meet and greet is the right place to walk through your specific insurance situation. Bring your card, your deductible info, and any HSA or FSA details. We'll show you exactly how membership would work for you.
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