Medicare Annual Enrollment Starts October 15: How Direct Primary Care Fits In

Medicare's Annual Enrollment Period runs October 15 through December 7 every year — the one window when you can change your Medicare Advantage or Part D prescription drug plan for the year ahead, with new coverage taking effect January 1. If you are on Medicare and have a Direct Primary Care membership, or are thinking about getting one, this is the right time to make sure the Medicare plan you are choosing actually works alongside your DPC doctor instead of fighting against it. Here is what to know.

First, a distinction that trips a lot of people up: the Annual Enrollment Period is not when you sign up for Medicare itself. If you are turning 65, you enroll in Original Medicare — Part A and Part B — during your seven-month Initial Enrollment Period centered on your birthday month, or during the General Enrollment Period from January 1 through March 31 if you missed it. The October 15 to December 7 window is specifically for switching your Medicare Advantage plan, switching your Part D drug plan, or moving between Original Medicare and Medicare Advantage for the following year.

Second, and this surprises most people: Medicare does not cover Direct Primary Care membership fees, the same way it does not cover concierge medicine retainers. DPC operates entirely outside Medicare billing, which is actually the reason most DPC physicians who see patients 65 and older have formally opted out of Medicare. Under federal rules, a doctor who opts out signs an affidavit agreeing not to bill Medicare for any patient for two years, and in exchange can enter into a private contract directly with Medicare beneficiaries — which is exactly what a DPC membership is.

You pay your DPC doctor directly, Medicare is never billed for those visits, and your Part B coverage for everything else stays completely untouched. This is worth confirming with any clinic before you enroll: ask whether your doctor has formally opted out of Medicare, since that status is what makes seeing Medicare patients under a DPC membership legally straightforward for the practice. Third, if you have a Health Savings Account from your working years, know that enrolling in Medicare Part A ends your ability to contribute to it.

The HSA rules that let working-age Floridians pay their DPC membership with pre-tax dollars do not apply once you are on Medicare — your DPC fee becomes a straightforward out-of-pocket cost, paid the same way you would pay for any service Medicare does not cover. You can still spend down an existing HSA balance on qualified expenses, including DPC membership fees at a qualifying practice, even after you stop contributing. Fourth, and this is where Annual Enrollment actually matters for DPC members: the type of Medicare coverage you choose affects how smoothly it pairs with your DPC doctor.

Medicare Advantage plans, especially HMOs, typically require you to select an in-network primary care physician and get referrals through that plan's network to see specialists. If your DPC doctor is not in that network — which is common, since many have opted out of Medicare entirely — referrals and coordination can get complicated, and some Advantage plans will not recognize visits with an out-of-network DPC physician as satisfying their primary care requirements. Original Medicare, Part A and Part B, has no network and no referral requirements.

You can see any specialist who accepts Medicare, anywhere, without your plan needing to know who your primary care doctor is. For Medicare beneficiaries who want a DPC membership for everyday primary care, pairing it with Original Medicare, a Part D drug plan, and often a Medigap supplement to cover the Part B coinsurance gap, tends to create far less friction than trying to layer DPC on top of a Medicare Advantage HMO. If you are currently on a Medicare Advantage plan and have been running into network or referral friction with your DPC doctor, the Annual Enrollment Period is your yearly opportunity to switch to Original Medicare plus a standalone Part D plan for the year ahead — a decision that needs to be finalized by December 7 for coverage starting January 1.

Medigap itself has its own separate enrollment rules, with the strongest guaranteed-issue protections available during the six-month window right after you first enroll in Part B, so if you are considering a supplement plan for the first time, it is worth looking into that timeline separately from Annual Enrollment. The bottom line for Florida Medicare beneficiaries considering Direct Primary Care: your DPC membership will always be an out-of-pocket cost, but which Medicare coverage you pick around it determines how well the two actually work together. If you are evaluating your Medicare options this Annual Enrollment Period and want a DPC membership to be part of your care plan for next year, confirm your clinic's Medicare opt-out status, lean toward Original Medicare over an Advantage HMO if network friction is a concern, and make any changes before December 7.

Browse our directory of 37 Direct Primary Care clinics across Orlando and Central Florida to find a practice that works with Medicare-age patients near you.