Portland, Oregon · Lote Tree Community Health
Explained by Dr. Jaleh Rahimi, a board-certified family physician caring for Northeast Portland families since 2017.
What is Direct Primary Care?
An Oregon-focused guide to the direct primary care model: how membership works, what it includes at Lote Tree, and how state law HB 2540 now lets many members apply payments toward their insurance deductible.
What Portland members get at Lote Tree
30 to 60 minute visits and direct phone/text access with Dr. Rahimi so NE Portland families can reach their physician without a portal queue.
Bilingual (English & Spanish) family medicine covering pediatrics through seniors, including prenatal continuity when families welcome new babies.
Membership care rooted in NE neighborhoods from Alameda and Beaumont to King and Woodlawn, with in-clinic visits plus statewide Oregon telehealth.
Transparent pricing plus guidance on Oregon HB 2540 and upcoming federal HSA rules so members know when payments may count toward deductibles.
Need more detail? Explore the full list of NE Portland neighborhoods we serve and review current membership pricing on our main page.
Author
Dr. Jaleh Rahimi, MD
Lifelong Oregonian, board-certified family physician, and founder of Lote Tree Community Health. Dr. Rahimi trained at OHSU, provides bilingual care (English & Spanish), and has delivered comprehensive primary care for Northeast Portland families since 2017.
Meet Dr. RahimiDefinition
Direct primary care (DPC) is a healthcare model where patients pay a monthly or annual membership fee directly to their primary care provider. This payment covers most primary care services without billing insurance.
Think of it like a gym membership for your primary care doctor: predictable monthly cost, direct access, no surprise bills.
What Portland Members Report
Recent Healthgrades and in-house testimonials cite longer, unhurried visits, bilingual support, and whole-family continuity with Dr. Rahimi. Review source links: Healthgrades profile, patient stories.
How Direct Primary Care Works
In a traditional healthcare model, your doctor bills your insurance company for each visit. This creates paperwork delays, shorter appointment times, and surprise bills when insurance doesn't cover what you expected.
Direct primary care removes insurance companies from your relationship with your primary care provider.
The Direct Primary Care (DPC) Membership Model
- Pay a monthly membership fee (typically $25 to $150 per month depending on age)
- Reach your doctor your way with office visits, video visits, phone calls, and text support
- Direct access to your doctor via phone, text, or email
- Longer appointment times (30-60 minutes instead of 15 minutes)
- Transparent pricing so you know exactly what you're paying each month
What Direct Primary Care Includes
Covered by Your Membership
- • Visit flexibility: In-office, video, and telephone visits (no extra charges)
- • Fast access: Timely appointments when it matters most
- • Comprehensive primary care: Wellness visits, urgent care, chronic disease management, prenatal care, newborn care, sports physicals
- • Common procedures: Stitches, skin biopsies, IUD/Nexplanon insertion, splinting, nebulizer treatments, and more
- • Whole-person care: Nutrition visits, mental health support, Pain Reprocessing Therapy, ceremony visits
- • Care coordination: Direct messaging with your doctor, specialist coordination, medication management
- • Transparent costs: Low-cost medications available directly from clinic, no surprise bills
Not Included (You Need Insurance For)
- • Emergency room visits
- • Hospitalizations
- • Surgeries
- • Specialist care
- • Advanced imaging (MRI, CT scans)
- • Expensive medications
- • Physical therapy
- • Mental health specialists
- • Dental and vision care
Important: Direct primary care is designed to handle 80-90% of your healthcare needs. For the other 10-20%, you still need health insurance or another safety net.
Does Direct Primary Care Replace Health Insurance?
No. Direct primary care does not replace health insurance.
This is the most common question people ask, and the answer is clear: direct primary care (DPC) covers your primary care needs, but you still need insurance for major medical events.
Why You Still Need Insurance
Consider what would happen if you:
- • Break a bone and need emergency surgery
- • Need treatment for cancer
- • Require hospitalization for a serious infection
- • Need an MRI or CT scan ($1,000-$3,000)
- • Require specialty medications ($500-$5,000/month)
These scenarios can cost tens or hundreds of thousands of dollars. Your direct primary care (DPC) membership cannot cover these. Health insurance protects you from financial catastrophe.
What Insurance Plans Work Best with Direct Primary Care (DPC)?
Many direct primary care (DPC) patients pair their membership with:
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Traditional insurance plans
Keep your existing insurance and add direct primary care (DPC) for fast scheduling, longer visits, and a doctor who knows you well.
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High-deductible health plans (HDHPs)
Lower premiums, higher deductibles. DPC handles everyday care, while the HDHP steps in for the rare, expensive events.
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Health Sharing Ministries
Faith-based cost-sharing for major medical expenses, paired with DPC for hands-on primary care and preventative support.
Who loves this setup most? Busy families who want same-week appointments, professionals who value unrushed visits, and people with HDHPs or sharing ministries looking to avoid surprise primary-care bills.
Direct Primary Care vs. Traditional Healthcare
Here's how the direct primary care (DPC) model compares to traditional insurance-based primary care:
| Direct Primary Care | Traditional Healthcare | |
|---|---|---|
| Cost Structure | Fixed monthly fee ($25-$150) | Copays, deductibles, coinsurance |
| Appointment Wait Time | Same-day or next-day | Days to weeks |
| Appointment Length | 30-60 minutes | 10-15 minutes |
| Communication | Direct phone, text, email access | Through office staff, portal messages |
| Surprise Bills | None for covered services | Common when insurance denies coverage |
| Visit Types | In-office, video, phone, home visits | Mostly in-office only |
| Insurance Billing | No insurance billing for primary care | Every visit billed to insurance |
| Doctor Relationship | Ongoing, personal relationship | Limited time to build rapport |
The key difference: Direct primary care (DPC) prioritizes your relationship with your doctor over paperwork and billing. Concierge medicine, on the other hand, charges a much higher retainer, often bills insurance, and adds luxury perks rather than lowering cost or simplifying access. DPC works best when paired with a high-deductible insurance plan for catastrophic coverage.
Direct Primary Care vs Traditional Insurance vs Concierge Medicine
| Feature | Direct Primary Care | Traditional Insurance | Concierge Medicine |
|---|---|---|---|
| Monthly Cost | $25 to $150 | $200 to $800+ premium | $125 to $400 per month ($1,500 to $5,000 per year) |
| Office Visit Copay | $0 (unlimited) | $20 to $50 per visit | $0 to $50 (varies) |
| Bills Insurance? | No | Yes | Usually yes |
| Appointment Length | 30 to 60 minutes | 10 to 15 minutes | 30 to 60 minutes |
| Wait Time for Appointment | Same or next day | 1 to 4 weeks | Same or next day |
| Direct Doctor Access | Yes (text, email, phone) | Limited (patient portal) | Yes (varies by practice) |
| Insurance Required? | No (but recommended) | N/A | Often required |
| Best For | Affordable, accessible primary care | Full medical coverage | Premium service, high income |
Quick takeaway: Traditional insurance is a comprehensive, employer-subsidized safety net, with premiums, deductibles, and copays covering everything from annual checkups to surgeries. Direct primary care strips out that insurance billing for everyday needs and replaces it with a simple $50 to $150 per month membership. Concierge medicine keeps the insurance billing in place but layers on a $1,500 to $5,000+ annual retainer for white-glove perks, so you pay premium fees plus the usual insurance costs.
Who Direct Primary Care Is a Good Fit For
✓ Patients who usually benefit
- • Busy families who want effortless access to one doctor they can text, see virtually, or visit in person without waiting weeks
- • People who crave preventive, whole-person care instead of rushed 10-minute visits and surprise bills
- • Small business owners or entrepreneurs who want a predictable, affordable benefit for themselves and their employees
- • Patients managing chronic conditions who need frequent touchpoints and easy access to their doctor
- • Uninsured or underinsured patients who prefer transparent monthly pricing over $300 to $500 urgent care visits
- • Individuals pairing a high-deductible plan with direct primary care to save 20 to 30% while covering 80 to 90% of routine needs
Most direct primary care practices cover roughly 80 to 90% of routine healthcare. Pairing membership with a high-deductible plan or health sharing ministry lets patients enjoy personalized, longer visits while keeping catastrophic coverage in place.
Frequently Asked Questions
Can I use direct primary care if I don't have insurance?
Yes. Direct primary care works whether you have insurance or not. Many uninsured patients use direct primary care (DPC) for their primary care needs while maintaining a high-deductible health plan, health sharing ministry, or catastrophic coverage for emergencies.
How much does direct primary care cost?
Direct primary care (DPC) membership fees typically range from $25 to $150 per month depending on your age and the practice. At Lote Tree Community Health, memberships start at $25/month for children (0 to 18) and $85/month for adults (19 to 65). View our pricing.
Can I use my health savings account (HSA) to pay for direct primary care in 2026?
Yes. Beginning January 1, 2026, the One Big Beautiful Bill Act (H.R. 1) allows qualifying direct primary care members to keep contributing to a health savings account (HSA) and reimburse their membership fees, and the IRS’s newly released Notice 2026-05 explains the guardrails. Keep the fee under $150/month for one member ($300 for households), make sure only primary care services are included, and pay the fee yourself because high-deductible health plan or employer payments still disqualify you. See the latest rules.
Can my direct payments count toward my deductible?
Before January 1, 2026: Oregon insurers are not required to credit direct primary care (DPC) invoices toward out-of-network deductibles, so keep invoices only for your records.
Starting January 1, 2026: Oregon HB 2540 requires Oregon-regulated plans (excluding health maintenance organizations, or HMOs) to credit approved invoices toward deductibles and out-of-pocket maximums when the service is medically necessary, the fee is below the carrier’s average in-network rate, and you submit the documentation yourself. We’ll provide itemized invoices with diagnosis codes and proof of payment so you can file them.
Source: Oregon HB 2540.
How do Oregon HB 2540 and federal H.R. 1 treat direct payments?
Before January 1, 2026: Health savings accounts (HSAs) generally cannot reimburse the monthly direct primary care fee if you already have a high deductible health plan, and HB 2540 has not started yet, so Oregon insurers are not required to credit your invoices toward out-of-network deductibles.
On or after January 1, 2026: Federal H.R. 1 lets qualifying direct primary care memberships (fees under $150/person or $300/family per month, primary-care-only services) be paid with health savings account funds, and HB 2540 requires Oregon-regulated plans (excluding health maintenance organizations, or HMOs) to credit approved invoices toward deductibles and out-of-pocket maximums. Keep invoices showing the fee, diagnosis codes, and proof of payment.
Sources: H.R. 1 (OBBBA), IRS Notice 2026-05, Oregon HB 2540.
What's the difference between direct primary care and concierge medicine?
The main differences are cost and insurance billing:
- • Direct primary care (DPC): $25 to $150 per month, does not bill insurance, focuses on affordability
- • Concierge: $1,500 to $5,000+ per year (often several thousand dollars depending on access level and geography), often bills insurance in addition to the membership fee, focuses on premium amenities
Can I switch from my current doctor to direct primary care?
Yes. You can join a direct primary care (DPC) practice at any time. Most patients keep their insurance for specialist care, prescriptions, and emergencies while using direct primary care (DPC) for all their primary care needs.
What happens if I need to see a specialist?
Your direct primary care (DPC) doctor will coordinate your care with specialists and help you navigate referrals. You'll use your health insurance to see specialists and pay any applicable copays or deductibles. Your DPC doctor remains your primary care coordinator throughout the process.
Is direct primary care the same as a health sharing ministry?
No. Direct primary care is a membership for primary care services. Health sharing ministries are cost-sharing programs where members pool money to pay for major medical expenses. Many people use both together: direct primary care (DPC) for primary care and a health sharing ministry for catastrophic coverage.
Can I use direct primary care if I don't have insurance? +
Yes. Direct primary care works whether you have insurance or not. Many uninsured patients use direct primary care (DPC) for their primary care needs while maintaining a high-deductible health plan, health sharing ministry, or catastrophic coverage for emergencies.
How much does direct primary care cost? +
Direct primary care (DPC) membership fees typically range from $25 to $150 per month depending on your age and the practice. At Lote Tree Community Health, memberships start at $25/month for children (0 to 18) and $85/month for adults (19 to 65). View our pricing.
Can I use my health savings account (HSA) to pay for direct primary care in 2026? +
Starting January 1, 2026, the One Big Beautiful Bill Act (H.R. 1) allows health savings account (HSA) contributions and reimbursements for qualified direct primary care memberships, and the IRS’s new Notice 2026-05 explains the details. Keep the fee under $150/month per member ($300 for multi-person memberships), include only primary care services, and pay the fee yourself.
Can my direct payments count toward my deductible? +
Before January 1, 2026: Oregon insurers are not required to credit direct primary care (DPC) payments toward out-of-network deductibles, so keep invoices only for your records.
Starting January 1, 2026: Oregon HB 2540 tells Oregon-regulated plans (excluding health maintenance organizations, or HMOs) to credit approved invoices toward deductibles and out-of-pocket maximums when the service is medically necessary, the fee is below the carrier’s average in-network rate, and you submit the claim yourself. We’ll give you itemized invoices with diagnosis codes and proof of payment.
Source: Oregon HB 2540.
How do Oregon HB 2540 and federal H.R. 1 treat direct payments? +
Before January 1, 2026: Health savings accounts (HSAs) generally cannot reimburse the monthly direct primary care fee if you already have a high deductible plan, and HB 2540 is not active yet, so insurers are not required to credit those payments.
On or after January 1, 2026: H.R. 1 lets qualifying direct primary care memberships (fees under $150/person or $300/family per month, primary care only) be paid with health savings account funds, and HB 2540 requires Oregon-regulated plans (excluding health maintenance organizations, or HMOs) to credit approved invoices toward deductibles. Keep invoices showing the fee, diagnosis codes, and proof of payment.
Sources: H.R. 1, IRS Notice 2026-05, HB 2540.
What's the difference between direct primary care and concierge medicine? +
The main differences are cost and insurance billing:
- • Direct primary care (DPC): $25 to $150 per month, does not bill insurance, focuses on affordability
- • Concierge: $1,500 to $5,000+ per year (often several thousand dollars depending on access level and geography), often bills insurance in addition to the membership fee, focuses on premium amenities
Can I switch from my current doctor to direct primary care? +
Yes. You can join a direct primary care (DPC) practice at any time. Most patients keep their insurance for specialist care, prescriptions, and emergencies while using direct primary care (DPC) for all their primary care needs.
What happens if I need to see a specialist? +
Your direct primary care (DPC) doctor will coordinate your care with specialists and help you navigate referrals. You'll use your health insurance to see specialists and pay any applicable copays or deductibles. Your DPC doctor remains your primary care coordinator throughout the process.
Is direct primary care the same as a health sharing ministry? +
No. Direct primary care is a membership for primary care services. Health sharing ministries are cost-sharing programs where members pool money to pay for major medical expenses. Many people use both together: direct primary care (DPC) for primary care and a health sharing ministry for catastrophic coverage.
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