How Direct Primary Care (DPC) Works with Minimum Essential Coverage (MEC)

If you're exploring ways to offer health benefits that keep costs low while meeting ACA requirements, you’ve likely come across Minimum Essential Coverage (MEC) plans. When designed properly, MEC plans can help employers stay compliant; however, they often fail to provide employees with access to the everyday care they actually need.

Employees want to know that if they get sick, need a prescription, or have a health concern, they can see a provider without long wait times, high out-of-pocket costs, or confusing networks. So, how do you offer that kind of benefit without paying the high premiums tied to traditional group health plans from major carriers like Aetna or UnitedHealthcare? That’s where Direct Primary Care (DPC) comes in.

In this article, we’ll explain what Direct Primary Care (DPC) is, how it works combined with a MEC plan, and how you can give employees access to quality primary care while staying fully ACA-compliant and keeping costs low for your budget.

Direct Primary Care (DPC) Overview

Direct Primary Care (DPC) is a subscription-based healthcare model that gives employees access to essential primary care services without going through traditional insurance. It also gives employers a more predictable, manageable way to offer healthcare, especially when paired with a MEC plan.

Instead of billing insurance for each visit, DPC operates on a flat monthly fee that covers most of the everyday care people actually use, such as routine checkups, sick visits, vaccinations, lab work, and care for minor injuries. For employees, that means no copays, no deductibles, and no surprise bills. For employers, it means a predictable cost structure and a benefit employees truly value and use.

The specific services included in a DPC membership may vary depending on the Direct Primary Care provider. It's important to review what's covered before selecting a plan. Below is a list of common services that are and aren’t included in DPC memberships.

What’s included:

• Routine checkups and wellness visits
• Sick visits and acute care for minor illnesses or injuries
• Chronic condition management
• Lab work and diagnostic testing
• Vaccinations and preventive care
• Mental health coaching and therapy (varies by provider)
• Same-day or next-day appointments
• Virtual or in-person visits (depending on provider)
• More access to providers via messaging or phone

What’s not included:

• Hospitalization or emergency room care
• Specialist visits (e.g., gastroenterologists, cardiologists, dermatologists)
• Complex procedures, surgeries, and outpatient services
• Advanced imaging (e.g., MRIs, CTs, ultrasounds)
• Insurance coverage or cost-sharing for major medical events
• Dental and vision care
• Certain medications
• Cosmetic surgeries or procedures