What if healthcare were designed to keep you well rather than treat your sickness? That’s the simple goal of membership-based healthcare.
While traditional health insurance is supposed to help patients afford care, the premiums, copays, deductibles, complicated billing, and surprise costs often do the exact opposite. In response, many people avoid healthcare, waiting until complications become serious.
Membership-based healthcare approaches care and the doctor-patient relationship very differently.
Quick Links:
- What is Membership-Based Healthcare?
- How Membership-Based Healthcare is Different from Health Insurance
- Direct Pay Healthcare vs Membership-Based Healthcare: Are They the Same?
- Membership-Based Healthcare vs Health Insurance: Cost Comparison
- Where Membership-Based Healthcare Does Better
- How Membership-Based Healthcare Supports Preventative Care
- Is Membership-Based Healthcare Right for You?
What is Membership-Based Healthcare?
Membership-based healthcare is unfamiliar to most people, but, like a gym membership, you pay a recurring monthly (or annual) fee that provides regular access to a set of predefined primary care services.
While every practice that offers a membership-based healthcare model offers different services, most (including Canby Clinic) include:
- Routine appointments
- Preventative care
- Basic screening and lab tests interpretation
- Care coordination
- Regular communication with your healthcare team
Many patients forgo essential visits because, with standard health insurance, costs are unpredictable and sometimes it’s hard to understand what’s covered. In contrast, healthcare membership models aim to make healthcare more accessible and costs more predictable while focusing on preventative and proactive care rather than waiting until something goes wrong or feels off.
How Membership-Based Healthcare is Different from Health Insurance
For many Americans, paying for healthcare is stressful. It often means relying on employer-provided health insurance, health savings accounts, or the health insurance exchange. Healthcare membership is a bit different. As with most insurance, healthcare insurance is really designed to protect people from the costs of large or unexpected medical care or emergencies.
Membership-based healthcare pays directly for access to proactive and preventive care, including routine exams, tests, and regular checkups and appointments.
Many patients end up using both: a membership for primary and preventative care and health insurance for major medical expenses like specialists, hospitalizations, emergency care, or
While you don’t need to choose between the two- in fact, they are complementary- the chart below shows the differences between the two.
| Membership-Based Healthcare | Health Insurance | |
| Payment | Monthly or annual fee | Monthly premium, deductibles, copays, or coinsurance |
| What’s covered? | A defined set of primary care services | Services covered by the specific health insurance plan you select |
| Routine appointments | Included in membership | Often require a copay or payment toward the deductible |
| Preventative care | Included as part of regular care, routine appointments, regular communication, and proactive support | Varies from plan to plan and depends on the service |
| Relationship to Doctor/Provider | You choose your doctor, longer visits, more consistent communication, collaborative | Dependent upon provider network, shorter/limited visits, and all dependent upon provider’s schedule and plan’s limitations/requirements |
| Billing | Managed directly with the practice/clinic | Claims are submitted to insurance companies (either by provider or patient). Bills can be unpredictable and delayed depending on what the patient owes and what their health insurance covers. |
| Provider Choice | Based on which practices offer a membership and which doctors are accepting new patients | Often limited by the insurance provider’s network. Outside network is often more expensive. |
| Unexpected or major medical | Some acute care, illness, or injury may be handled, depending on the level of care needed or provided. | May help cover emergency care, hospitalizations, specialists, major surgeries, medical specialists, or other major expenses |
| Cost predictability | Primary and routine care costs are generally covered and easier to anticipate. | Costs vary depending on copays, deductibles, in- or out-of-network doctors, and coinsurance. |
Perhaps the easiest way to think about the difference is that insurance is designed primarily for major medical expenses and for services specifically covered by the plan, whereas membership-based healthcare provides everyday, routine care directly.
While the services covered by a specific practice may vary, most membership terms include routine and primary care services that many patients put off due to the lack of predictability around cost or access.
Direct Pay Healthcare vs Membership-Based Healthcare: Are They the Same?
So is membership-based healthcare the same as direct pay? This is a great question because they’re similar, in that they both mean patients can see their doctors without billing health insurance, but the structure is a little bit different.
With direct pay healthcare, patients pay the practice for each billable item, from appointments to tests and procedures. Unlike traditional insurance billing, direct-pay pricing is often provided to the patient up front, making costs more transparent.
With membership-based healthcare, there’s a recurring fee for a set of predetermined services. The membership often covers routine visits and checkups, basic screening exams, preventative care, and care coordination, communication, and collaboration.
Direct pay is pay-per-service, whereas membership-based healthcare allows you to pay monthly or annually for regular access to care and doctors, as well as standard routine care.
Some practices use both models, including a set number of services under the membership model, while using the direct-pay structure for services or treatments outside the membership. In some cases, patients may opt to join a clinic using a membership model, and then rely on insurance for major medical expenses or services the clinic does not provide.
It’s important to have these discussions with the clinic you choose to understand how they handle payments outside the membership model. You’ll want to be clear on what is included, what might cost extra, and what might need to be billed through insurance.
Membership-Based Healthcare vs Health Insurance: Cost Comparison
This comparison is a little less direct, in that membership-based health care is designed to improve access to doctors and enhance preventive care. In contrast, while health insurance often covers annual exams and some tests, it’s primarily designed to protect people from major medical expenses such as surgeries, emergency care, specialist visits, and hospitalizations.
In other words, much like direct pay and membership-based healthcare, they can work in tandem with one another, with insurance providing protection against major medical bills while membership at a clinic can provide regular and routine care.
For many patients, it’s high healthcare premiums that lead them to seek alternatives. The truth is that health insurance has become increasingly difficult for many people to afford. In fact, in 2025, the Kaiser Family Foundation (KFF), an independent healthcare policy research organization, found that the average annual cost for employer-sponsored insurance was nearly $10,000 and over $25,000 for a family. And, for many, that doesn’t cover regular doctor visits without deductibles, copays, and out-of-network costs.
In fact, that same Kaiser research found that in 2025, the average deductible for an individual was nearly $2,000, with over 1/3 of patients enrolled in a plan with a higher deductible. Further, the average copay for a patient with health insurance is $27 for a primary care visit and $45 for a specialist visit.
All of that adds up when it comes to routine care. With health insurance, patients may pay at multiple points through premiums, deductibles, copays, and potentially separate charges for labs, procedures, or out-of-network doctors.
In contrast, many membership-based clinics charge between $50 and $ 100 monthly for access to primary care, depending on what’s included. This is transparent and predictable, and it means many patients can schedule the regular visits they want, get follow-up care, and prioritize preventive care before health concerns demand more costly immediate, emergency, or even long-term care.
Health insurance is still important for major medical needs, but when it comes to getting regular, proactive, preventive primary care that keeps patients healthy, memberships offer day-to-day value for patients who want that care and regular access to their doctors.
Where Membership-Based Healthcare Does Better
The simple answer is that membership-based healthcare helps to provide the routine care many Americans want access to. For many patients who rely solely on health insurance, membership-based healthcare can provide significant benefits including:
- Predictable costs for defined primary care services
- Lower financial barriers for routine care (no repeated copays)
- More frequent and easier access to routine and follow-up care
- Longer visits with time for questions, conversation, and patient education
- A more collaborative relationship with your healthcare team and providers
- Stronger emphasis on proactive and preventative care
- Greater attention to health trends and changes as well as symptoms and how they may be connected
- Less time managing payments and more time spent on care
- A clear, transparent understanding of what your care costs
Too often, patients relying on health insurance delay healthcare because of costs, whether that’s the expense or lack of transparency. Ultimately, that affects the level of care they receive and their ability to prevent more serious health issues over time.
How Membership-Based Healthcare Supports Preventative Care
With traditional healthcare and health insurance, many patients put off care until they’re sick enough to justify a doctor’s visit, whether that’s because insurance will cover a sick visit or the copay or bill is an added expense they’d rather avoid.
Membership-based healthcare flips the script by making routine primary care easier to schedule and making the relationship with a care team more open, communicative, and collaborative. There’s time to discuss concerns, health history, risks, and to monitor health trends and changes. Those take time and routine visits, especially when trying to prevent concerns before they develop or become serious.
For example, the CDC’s National Diabetes Prevention Program found that proactive changes to nutrition and activity level, paired with moderate weight loss, reduced the risk of developing type 2 diabetes by 58%. That number increases to 71% among patients aged 60 and older. Without preventive care, regular visits to doctors, and regular monitoring of health conditions, staying on top of proactive and preventive care can be challenging for many.
Not only does preventive care improve health, but it also helps reduce long-term or costly medical issues. One great example of this is with cancer screening. In fact, the National Cancer Institute estimates that 79% of the nearly one million colorectal cancer deaths that were avoided between 1975 and 2020 were averted due predominantly to screening.
Similarly, the CDC estimates that regular blood pressure screening and clinical monitoring could reduce heart attacks by 4.9%, reduce strokes by 3.8%, and provide nearly $8,000 in healthcare savings per person over two decades. Regular primary care and routine visits make it far easier for doctors to identify risks, identify high blood pressure, track changes, and provide support before it leads to more dangerous and costly healthcare needs.
Is Membership-Based Healthcare Right for You?
Not every preventive care service yields dramatic returns on a person’s health (or wallet), but screenings, labs, risk assessment, lifestyle analysis and support, and condition management can help prevent illness and more serious conditions while also improving outcomes over the long term.
Instead of seeing healthcare as “sick care,” membership-based healthcare allows patients and their care team to reframe it, fostering a relationship between doctor and patient that often results in more comprehensive care.
The goal of membership-based healthcare is to provide patients with the opportunity to access their doctors regularly, without fear or hesitation. It opens the door for more questions and conversations that help patients understand their risks and work with care teams to build realistic plans for better health, monitor progress on those plans, and, ultimately, shift the focus from reacting to illness to protecting and promoting health and restoring vitality.
Canby Clinic offers a membership that provides routine care, lab testing, follow-up appointments, and some treatments as part of standard care. If you’re interested in exploring membership as a way to improve your health and work proactively with a healthcare team, then reach out and schedule a consultation today!