The average American family with employer coverage now pays $28,303 a year in health insurance premiums, counting what the employer chips in, according to KFF's 2026 Employer Health Benefits Survey, released Oct. 22. The share workers pay out of their own paychecks jumped 9 percent in a single year to $7,471. Over the past five years, family premiums have risen 28 percent, outpacing both wages and inflation.
For all that money, many patients still wait weeks for a primary care appointment, get a rushed visit when they finally arrive and then chase a portal message that goes unanswered for days.
Dr. Sarfaraz Dhanji is offering a different deal.
At Magnus Direct Primary Care in Jacksonville, Florida, adults ages 18 to 64 pay a flat $135 a month. Patients 65 and older on Medicare pay $125. New members pay a one-time $140 enrollment fee. After that, the monthly fee buys ongoing access to their physician without a bill for every visit. Dr. Dhanji also makes house calls, for an additional fee. When someone needs a cardiologist, an orthopedic surgeon or another specialist, he acts as the liaison, making the connection and coordinating the handoff himself instead of leaving the patient to navigate it alone.
It is a model built around the patient's schedule rather than the system's.
Why he left corporate medicine
Dr. Dhanji, a board-certified family physician with 18 years in medicine, spent much of his career inside the traditional fee-for-service system. He described the breaking point in a recent profile in The Script Pad, the independent publication for physicians.
"Medicine was never meant to be about numbers, quotas, or corporate profits. It was meant to be about people," Dr. Dhanji told The Script Pad.
In that system, he says, appointments were rushed to keep the schedule moving. Patients whose conditions were under control could be pushed onto different drugs when an insurer rewrote its list of covered medications. Doctors were asked to put in punishing hours to carry an overhead and management structure that, as he saw it, added little to anyone's care. He left to open Magnus Direct Primary Care, where treatment is worked out by the physician and the patient alone.
His frustration reflects a profession that has changed dramatically in a short time. As of January 2026, 82 percent of U.S. physicians were employed by hospitals, health systems or other corporate entities, according to an Avalere Health analysis for the Physicians Advocacy Institute. Only 18 percent still practice in physician-owned settings. In 2018, by the same count, 52 percent of physicians were employed. A majority of employed physicians surveyed by NORC at the University of Chicago said ownership changes hurt both patient care and physician autonomy.
The math of a typical corporate primary care practice is brutal. A widely cited study in the Journal of General Internal Medicine estimated that a primary care physician with a standard panel of 2,500 patients would need 26.7 hours a day to deliver all the preventive, chronic and acute care that national guidelines recommend. There are only 24 hours in a day.
Direct primary care solves that problem by shrinking the panel. Physicians who consider their practices full typically care for roughly 400 to 700 patients, according to a national survey led by Dr. Kenneth Qiu for the Direct Primary Care Alliance and reported by Medical Economics. Fewer patients means longer visits, same-day access and a doctor who actually knows your history.
Subscription, insurance or concierge
The three models are often confused, but they work very differently.
In traditional insurance-based primary care, every visit is a billed transaction. The patient pays a premium every month, then a copay or deductible on top of it, and the practice gets paid by volume.
In direct primary care, the patient pays the practice a flat monthly membership that covers primary care services, and the practice does not bill insurance for those services. Members typically keep insurance or Medicare for hospital stays, emergencies and specialist care, since a membership is not an insurance plan. The two work together. A flat fee covers the everyday care most people use, and insurance sits in the background for the big events.
Concierge medicine also charges a membership, but it usually bills insurance as well. Physicians on a recent Medical Economics panel drew that distinction plainly, noting that direct primary care removes insurance from the relationship entirely while concierge practices often bill insurance alongside the fee. Concierge memberships commonly run $2,000 to $5,000 a year and can climb much higher at premium practices.
Dr. Dhanji's adult membership works out to $1,620 a year. The national average for direct primary care is about $98 a month, according to the Direct Primary Care Alliance survey. His fee sits above that average, and his patients get a physician who will also come to them at home when needed.
There is a new tax advantage, too. Under the One Big Beautiful Bill Act, starting Jan. 1, 2026, direct primary care memberships became eligible to be paid with Health Savings Account dollars, as long as the fee stays at or below $150 a month for an individual or $300 a month for a family. Dr. Dhanji's $135 adult rate fits under that cap, which means many patients can now pay for their doctor with pretax money.
Cheaper medications change the equation
Primary care is only part of a family's health spending. Prescriptions are the other part, and that side of the market is shifting as well.
Mark Cuban launched the Mark Cuban Cost Plus Drug Company in January 2022 with a simple pricing formula. It charges the manufacturer's cost plus a 15 percent markup and a small pharmacy fee, and it does not run prescriptions through insurance. Researchers at Brigham and Women's Hospital, writing in the Annals of Internal Medicine, estimated that Medicare could have saved about $3.6 billion in 2020 by buying 77 common generic drugs at Cost Plus prices. The study also cited an estimate that the supply chain keeps 64 percent of what is spent on generic drugs.
The federal government has moved into the space as well. In February 2026, the White House launched TrumpRx.gov, a website tied to "most favored nation" pricing deals with 16 of the largest drugmakers. The site does not sell medication itself. It directs patients to manufacturers' direct-to-consumer cash prices or to pharmacy coupons, including GLP-1 weight-loss drugs the government says will average $149 to $350 a month. Critics note that many insured patients still pay less through their own plans, and the site launched with a limited list of drugs.
For a direct primary care physician, these options matter. A doctor who is not tied to an insurer's formulary can help a patient find the cheapest legitimate source for a prescription, whether that is a cash generic, a manufacturer program or the patient's own plan. Pair a predictable monthly membership with transparent drug prices, and a family can finally see what routine care will cost before the bill arrives.
A growing movement, and its critics
More than 2,700 direct primary care practices were operating across the United States as of January, according to the advocacy group DPC Frontier, as reported by Kiplinger. A Health Affairs study published in December 2025 found that concierge and direct primary care sites grew from 1,658 to 3,036 between 2018 and 2023, an increase of 83 percent, while the number of clinicians working in them rose 78 percent, according to Medical Economics. Jacksonville alone has 15 direct primary care and concierge practices on one national directory.
The growth has drawn real scrutiny. The Health Affairs authors write that it is unclear whether the shift eases or worsens physician shortages, and coverage of the research has raised the concern that patients who cannot follow their doctors into smaller membership panels may find it harder to get care in an already strained system. Supporters counter that primary care access was eroding long before membership models caught on, and that corporate consolidation has grown far faster than direct care over the same period.
For Dr. Dhanji, continuity is the whole argument. Billing by the visit, he says, reduces medicine to a series of one-off encounters. A membership keeps one doctor with one patient year after year, and that history is where trust and better care come from. Outside recognition has followed, with a place on the 2026 Best of Florida list for physician practices and a 2026 Top Doctor nod from Jacksonville Magazine.
"My greatest measure of success isn't how many patients I see or how much revenue I generate," he told The Script Pad. "It's knowing that I've made a meaningful difference in someone's life while remaining true to the physician I always wanted to be."
For households watching a $28,000 premium eat into the budget, that pitch is landing. A doctor who answers the phone and will come to the house used to sound like a luxury. At $135 a month, it is starting to sound like a bargain.
About Dr. Sarfaraz Dhanji
Dr. Sarfaraz Dhanji, MD, is the owner of Magnus Direct Primary Care in Jacksonville, Florida. He is board certified by the American Board of Family Medicine and has 18 years in practice. Learn more at magnusdpc.com or read his full profile in The Script Pad.
Premium figures are from KFF's 2026 Employer Health Benefits Survey, released 22 October 2026. Physician employment figures are from the Avalere Health analysis for the Physicians Advocacy Institute, and the NORC findings are as reported by Medical Economics on 13 May 2026. The 26.7-hour estimate is from Porter et al., Journal of General Internal Medicine, 2022. Panel sizes and the average membership fee are from the Direct Primary Care Alliance survey led by Dr. Kenneth Qiu, as reported by Medical Economics on 12 October 2026. The concierge distinction is from a Medical Economics physician panel published 4 August 2026, and the concierge fee range is from PartnerMD. The HSA provision is from the One Big Beautiful Bill Act and IRS Notice 2026-05. Medicare savings estimates are from Lalani et al., Annals of Internal Medicine, 2022. TrumpRx details are from Reuters, as published by KSL on 6 February 2026. The DPC Frontier count is as reported by Kiplinger, and the Health Affairs findings (Zhu et al., December 2025) as reported by Medical Economics on 27 August 2026. The Jacksonville count is from the Tabflows DPC Finder. Dr. Dhanji's fees, credentials and recognitions are from Magnus Direct Primary Care, and his quotations are from his profile in The Script Pad.
Topics healthprimary carehealth insurancephysiciansFlorida
