Question 1

Is Direct Primary Care legal in Kentucky?

Accepted Answer

Yes. Kentucky has had a dedicated DPC law since 2017. SB 79 was enacted March 17, 2017 (effective June 29, 2017), making Kentucky the 18th state with DPC legislation. It's codified at KRS §§ 311.6201–311.6202 and is widely regarded as one of the best-written DPC statutes in the country.

Question 2

How much does Direct Primary Care cost in Kentucky?

Accepted Answer

Adult DPC memberships in Kentucky typically run $65–$149 a month. Family plans usually cost less per person, and kids' memberships come in cheaper than adult ones. Pricing varies by city and practice, so browse Kentucky practices to compare real numbers.

Question 3

Is a DPC agreement considered insurance under Kentucky law?

Accepted Answer

No. Kentucky law keeps DPC entirely outside insurance regulation. Under KRS 304.1-120(9), no provision of the Kentucky Insurance Code applies to a direct primary care agreement. KRS 311.6202(2) goes further, stating that DPC "shall not be deemed an offer or provision of coverage under a health benefit plan and shall not be regulated under KRS Chapter 304."

Question 4

Can a Kentucky DPC doctor also bill my insurance for the same services?

Accepted Answer

No. Kentucky law requires the agreement to state that the provider won't bill a health plan or Medicaid for the covered services. No. KRS 311.6201(1)(c) requires the agreement to state that the provider "shall not bill a health benefit plan or the Medicaid program on a fee-for-service basis for the primary care services provided under the agreement."

Question 5

Can a third party, like my employer, pay my DPC membership fee in Kentucky?

Accepted Answer

Yes. Kentucky law explicitly allows an employer, guardian, family member, or state program to pay your DPC fee. Yes. Kentucky's law explicitly defines "third party" to include a patient's employer, spouse's employer, legal guardian, or family member, as well as a state-sponsored DPC payment program. The agreement has to state that fees may be paid by a third party, one of Kentucky's standout consumer-friendly provisions.

Question 6

What must a Kentucky DPC agreement include?

Accepted Answer

Under KRS 311.6201, it must spell out covered services, no fee-for-service billing, fees, a 12-month prepayment cap, termination rights, refunds, and a not-a-health-plan disclosure. Under KRS 311.6201, the agreement must describe covered services, state that no health plan will be billed on a fee-for-service basis, specify additional fees, cap prepayment at 12 months, allow either party to terminate without penalty, require return of unearned fees, and prominently state that the agreement isn't a health benefit plan.

Question 7

Do I still need health insurance if I join a Kentucky DPC practice?

Accepted Answer

Yes. DPC isn't a substitute for health insurance. KRS 311.6202(1) states that getting primary care under a DPC agreement "shall not require a patient to forfeit coverage under a health benefit plan." DPC handles primary care; you still need coverage for hospitals, specialists, and emergencies. Learn how DPC fits into your coverage.

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Kentucky DPC laws & FAQ

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Kentucky DPC laws & FAQ

Direct Primary Care
Doctors in Kentucky