On a High Deductible Health Plan? You Are Already Paying Cash for Primary Care

You chose a high deductible health plan because the premium was lower and the deductible looked survivable. Then the year started. The visit to ask about fatigue cost the full negotiated price. The labs cost more. The follow-up to hear that the labs were normal cost again. By spring you had learned the lesson every high-deductible reader learns: until the deductible is met, you are paying cash for primary care, and the primary care you are paying cash for is the eight-minute visit.

This piece is for that reader, and its argument is short. You are already paying out of pocket for primary care. The only question is what version of primary care that money buys.

The year under the deductible

A high deductible health plan has one job it does well: it caps the catastrophe. Past the deductible and the out-of-pocket maximum, the plan pays. For a hospital admission, a surgery or an emergency, that cap is the reason to carry the plan, and nothing in this piece suggests otherwise.

What the plan does badly is the ordinary year. The 2025 Employer Health Benefits Survey from the Kaiser Family Foundation puts the average annual deductible for single employer coverage at $1,886, and on the individual market a bronze plan's deductible runs several times that. Most people on these plans never reach the deductible in a year without a major event. So for the visits that make up a normal year, the plan is a discount card: you pay the negotiated rate, in full, and the visit counts toward a deductible you will not meet.

The reader who learns this stops going. Not out of carelessness, but out of arithmetic. The fatigue goes uninvestigated because the investigation is a bill. The follow-up on the borderline blood sugar is postponed because the follow-up is a bill. The medication question is never asked because the visit to ask it is a bill and the answer, in a short visit, is usually no. The deductible against direct primary care math traces one household through exactly that year.

There is one more cost the deductible hides, and it is the referral. When the short visit cannot resolve the question, the answer is a specialist, and under a high deductible health plan the specialist is another full-price visit, often with a wait of weeks or months, for a problem that a clinician with time and the right labs might have handled in a message. The referral is not wrong in itself; some problems need a specialist. But a great many of the referrals a high-deductible reader pays for are the per-visit model handing off work it had no time to do, and the reader pays twice: once for the visit that referred, once for the visit that was referred to. The eight-minute model does not only cost you the visit. It costs you everything the visit could not finish.

What the cash is buying

Here is the part that is easy to miss when every visit stings. The money you pay under the deductible is not buying worse care than an insured visit would. It is buying the same care, the care the insurance-based model can afford to deliver, and you are seeing its price without the plan softening it.

An insurance-based practice is paid per visit, per code, so it lives on volume. A clinician in that model typically manages 2,000 to 3,000 patients. The visit is short because the panel is large, and the panel is large because the model pays that way. A lab result comes back with a reference range and a word, normal, and the clinician has no time to read it against the result from last year, your family history or the way you have been feeling. The eight-minute visit problem sets out why none of this is the clinician's fault.

A direct primary care practice is paid differently. The patient pays a flat monthly fee, and the practice is paid to know that patient rather than to see as many as possible. The national survey of direct primary care practices describes the model: smaller panels, typically 300 to 600 patients to a clinician, and a fee that covers the visits instead of billing each one. Under that model the follow-up is not a bill, the message is not a bill, and the lab panel is already paid for, so none of them gets skipped.

What the same money buys inside the membership

The GoodLife Health membership is $299 a month, month to month, which is $3,588 a year. $598 is charged at sign-up and covers the first two months. For that you get clinicians licensed in all fifty states, four cardiometabolic lab panels a year, every result in your own hands, asynchronous messaging with your care team, and video visits. Nothing is billed to your plan, so there is no copay, no claim, and no surprise statement six weeks later. The fee is the same whatever medication is indicated and whatever the dose.

The honest comparison is this. For the reader who needs one or two visits a year, the cash they spend under the deductible is a few hundred dollars, and the membership would cost them more. For the reader who needs a clinician's time several times a year, who wants labs read against their history rather than against a range, who has a question about weight, hormones, thyroid or blood pressure that keeps being deferred, the membership turns an unpredictable stream of bills into one fee that covers the care, and it buys a version of primary care the deductible never could.

The plan stays. Most members pair the membership with exactly the low-premium high deductible health plan they already have, keeping it for hospital, emergency, imaging and specialty care. The membership fee is generally eligible for HSA or FSA pre-tax dollars, which is how many members pay it. One trade is worth naming: lab panels inside the membership are not billed to your plan, so they do not count toward the deductible. For the reader who rarely reaches it, that rarely matters.

Medication is separate. When a medication is indicated, the clinician prescribes it to the pharmacy you choose, at that pharmacy's own price. GoodLife Health sets nothing, sees nothing and takes nothing on medication, and prescribes only branded, FDA-approved medication, never compounded GLP-1. Whether your plan covers a medication is between you, your plan and the pharmacy, and prior authorization is the pharmacy's process, so neither is promised. The real ROI of the membership prices the full year, medication included, against every alternative, with dates.

What four panels a year catch that one physical misses

The reader on a high deductible health plan usually keeps the one visit the plan covers in full, the annual preventive physical, and skips the rest. That physical orders a standard panel once a year, and it is read once, against a range. For cardiometabolic risk, that is the wrong instrument at the wrong interval.

Cardiometabolic risk is a direction, not a value. A fasting glucose or an HbA1c inside the range this year tells you little; the same number compared with last year's and the year before tells you whether you are drifting toward a diagnosis while every single result was still called normal. A standard panel often omits the markers that move first, such as ApoB and fasting insulin, so the annual physical can be reassuring for years about a risk it never measured. The ApoB test cost guide shows what one of those markers costs to buy on your own, four times a year, and why inside the membership it is simply included.

Four panels a year, read by the same clinician against the same history, turn the snapshot into a trend. They are included in the fee, which matters under a deductible for a reason that has nothing to do with money: when the next panel is already paid for, nobody rations it. The follow-up you would have skipped because it was a bill happens, and it happens on schedule.

The arithmetic of paying with pre-tax dollars

Most readers on a high deductible health plan have a health savings account, because the plan is what makes them eligible for one. The membership fee is generally eligible for HSA or FSA pre-tax dollars, and many members pay it that way. The word is generally, and it means what it says: confirm with your plan administrator before you count on it. But for the reader who qualifies, paying the fee pre-tax lowers what the membership costs them in take-home terms, and it does so with money that was already set aside for exactly this kind of spending. The care you used to pay for under the deductible, visit by visit, was already coming out of that account; the membership moves it from an unpredictable stream of bills into one fee, paid the same way.

One clarification, because a careful reader will want it. Spending inside the membership is not billed to the plan, so it does not count toward the deductible. For the reader whose year rarely reaches the deductible anyway, nothing is lost. For the reader who expects a major event this year and wants every dollar to count toward the out-of-pocket maximum, that is worth knowing before they decide, and it is the kind of thing a clinician here would say plainly in the first conversation rather than let you discover on a statement.

The honest close

A high deductible health plan makes one thing visible that a low-deductible plan hides: the real price of the primary care you are getting. Once you can see it, the choice is clear and it is not the choice between insurance and a membership. It is the choice between paying cash, visit by visit, for the model that cannot know you, and paying a flat fee for the model that is paid to. The plan covers the rest either way.

Not everyone is accepted. After the eligibility check, the intake and the checkout, a clinician reviews your case and decides. If they cannot accept you into care, the $598 is refunded in full; once you are accepted, the first two months are non-refundable.

Who this is not for

If you are healthy, take no medication, and your year under the deductible costs you a few hundred dollars, keep paying cash under your plan. The membership would cost you more than the care you use, and this piece will not pretend otherwise.

If you want the membership to count toward your deductible or to pay for a hospital stay, it does neither. It is a primary-care relationship, not coverage.

If you want the cheapest possible prescription and nothing else, a $99 a month app is a different product, and GoodLife Health does not prescribe compounded GLP-1 to compete with it.

Related Reading

• Insurance Deductible vs Direct Primary Care: The Real Math
• An Alternative to Traditional Insurance: What a $299 Membership Replaces
• The Eight Minute Doctor Visit Problem
• The Real ROI of a $299/Month Health Membership
• Can I use my HSA for a health membership?

References

1. 2025 Employer Health Benefits Survey — Kaiser Family Foundation. 2025. www.kff.org/health-costs/2025-employer-health-benefits-survey/
2. Direct Primary Care: Practice Distribution and Cost Across the Nation (J Am Board Fam Med). 2015. pubmed.ncbi.nlm.nih.gov/26546651/