Question 1

Is Direct Primary Care legal in Maine?

Accepted Answer

Yes. Maine has had a dedicated DPC law since 2017. Its DPC "not insurance" law (SP 0472) was enacted June 1, 2017, making Maine the 23rd state. It's codified at 22 M.R.S. § 1771, and DPC practices operate actively throughout the state with support from the Maine Academy of Family Physicians.

Question 2

How much does Direct Primary Care cost in Maine?

Accepted Answer

Adult DPC memberships in Maine typically run $59–$139 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 Maine practices to compare real numbers.

Question 3

Is a DPC agreement considered insurance under Maine law?

Accepted Answer

No. Maine law explicitly says a DPC agreement is not insurance. Under 22 M.R.S. § 1771, a direct primary care agreement isn't insurance and isn't subject to the Maine Insurance Code. The Maine Department of Insurance confirmed this in Bulletin 434.

Question 4

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

Accepted Answer

No. Maine law bars a DPC practice from billing your insurer for primary care already covered by your agreement. No. Maine law prohibits a DPC practice from billing a third-party insurer for primary care services already covered under the DPC agreement. The membership fee is the full payment for those covered services.

Question 5

Does Maine have any special protections for DPC referrals?

Accepted Answer

Yes. A 2019 Maine law makes insurers honor referrals from DPC providers the same as in-network referrals. Yes. Maine passed a landmark additional law in 2019 (S.P. 372-L.D. 1197) that stops insurance carriers from denying covered services just because the referral came from a DPC provider outside their network. Carriers have to treat a DPC referral the same as one from a participating in-network primary care provider.

Question 6

What must a Maine DPC agreement include?

Accepted Answer

Under § 1771, it must be a written agreement covering services, the periodic fee, termination terms, and a prominent not-insurance disclosure. Under § 1771, the agreement has to be written, describe the services it covers and the periodic fee, spell out how either party may terminate, and prominently disclose that it isn't health insurance.

Question 7

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

Accepted Answer

Yes. DPC isn't a replacement for health insurance. It covers most day-to-day primary care but not hospitalizations, ER visits, specialist care, or surgeries. Most Maine DPC members pair their membership with a high-deductible health plan for that coverage. Thanks to Maine's 2019 referral law, your DPC doctor's specialist referrals get honored by your insurer. Learn how DPC fits into your coverage.

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Maine DPC laws & FAQ

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Maine DPC laws & FAQ

Direct Primary Care
Doctors in Maine