More Americans turn to cash-only doctors as health care costs rise

[BumRushDaShow]

Source: Scripps News

Posted 10:47 AM, Jan 05, 2026


Affordable Care Act subsidies have officially expired, affecting tens of millions of Americans who get their insurance through the marketplace. With private and employer-sponsored plan costs also rising, more people are turning to a different kind of system — paying cash directly to their doctor. The direct primary care model, where patients pay a monthly fee for visits, is gaining momentum across the country. The American Academy of Family Physicians estimates nearly one in 10 of its members operate a direct primary care practice, a number that has tripled in just a few years.

"Eighty-nine dollars a month, unlimited, and you don't get any other bills for any other care. Totally unrestricted and unlimited," said Jacqueline Robson, vice president of member services at Hy-Vee Health Exemplar Care. Robson spoke to Scripps News during the opening of a new location in Omaha, Nebraska. The organization bills itself as the "Midwest's leading direct primary care provider," with locations in Nebraska, Iowa, Missouri and South Dakota.

The ability to spend more time with patients is what drove Dr. Rahul Iyengar to open his own direct primary care practice in Nashville, Members Health Co. "As a doctor, I want to talk to you for an hour, hour and half and that's what I do here since I'm outside the system. In the system, doctors don't get to make their schedule. You're an employee and insurance is really what dictates their schedule," Iyengar said.

Dr. Rachel Dhani, who owns House of Valor in Tampa, transitioned to direct primary care early in her career after working in a traditional hospital and insurance-based setting. "Freedom is everything. I have joy when I take care of patients and my colleagues who are in insurance-based models, they don't have joy. They are just completely drained from the administrative pressures of these insurance models and patients aren't happy," Dhani said.

Read more: https://www.scrippsnews.com/politics/health-care/more-americans-turn-to-cash-only-doctors-as-health-care-costs-rise

[OC375]

1. What Comes Around...

This is how I remember it working when I was a kid. See the doctor, pay the doctor, done. Unless you were dealing with more than a broken arm that was it. Now it's all minute clinics and copays and endless tests and follow ups and disclosures and health histories, just to get simple healthcare. An exodus is a good thing!

Tune in, turn on, drop out.

[Jacson6]

3. Dr's here in CA are going health insurance plus service fees, if I need a prescription refill or other services.

The VA pays my DR $300 per appointment and if I need anything after the appointment I have to pay a fee for the service.

[reACTIONary]

4. I don't believe there is a doctor who...

.... spends an hour or an hour and a half with any one patient. And I don't understand why it would be necessary. This sounds like a gross exaggeration.

[brer cat]

5. It depends on the diagnosis and complexity.

I was treated last year for breast cancer. My initial visit with my surgeon took an hour and a follow up when the the pathology report showed cancer cells remaining after surgery also took about an hour. All of my visits with the oncologist take at least an hour.

My annual wellness check up with my PCP takes 45 minutes to an hour. She is very thorough and gets reports from every other physician that I see. She is the glue that holds my health care together.

[Nigrum Cattus]

6. no other country has this problem

we pay the most and don't get the best outcomes

[BidenRocks]

7. Are we still required to show proof

of insurance when we file taxes?

[WestMichRad]

8. Good luck to them finding competent care when they need specialists.

Nt