Membership Primary Care · Self-Pay
Primary care without insurance: what it costs and how it works
Being uninsured, or insured with a deductible you never reach, should not mean going without a primary care provider. This page explains exactly what self-pay membership care costs at Presence, what it does not cover, and how to judge whether it is a better use of your money than paying cash per visit.
Virtual membership from $19.99/month · $129 per local in-office visit · No insurance required
The short answer
- In one sentence
- You pay a flat monthly membership instead of using insurance for primary care. Virtual care is included with no copay, and local in-office visits are $129 each on the $19.99 plan, or two included a year and then $99 each on the $29.99 plan — or carry no per-visit charge, if you hold an Unlimited membership.
- What it costs
- Virtual Family Care is $19.99/month and Virtual + Local In-Office Care is $29.99/month. Individual Unlimited is $79/month for ages 19–44, $89 for ages 45–64 and $109 for ages 65+. Family Unlimited is $219/month for a family of up to five, plus $29 per additional child after five; medically appropriate local visits are included.
- What it is not
- It is not health insurance and it does not pay hospital, emergency, surgical or specialty bills. Many members keep a high-deductible or catastrophic plan for those costs and use membership for everyday care.
- Who it suits
- Self-employed and 1099 workers, people between jobs, early retirees before Medicare, and anyone whose deductible is high enough that they avoid care until something gets worse.
- Next step
- Compare the four memberships, or start with a virtual visit and decide about local care afterwards.
This page sits under direct primary care — start there if you want the full picture first.
Paying yourself — which is cheaper for you?
- See prices
One or two visits a year
Pay per visit: one-time virtual care starts at $19.99; a non-member scheduled local visit is $149.
- Compare memberships
Regular care, a chronic condition, or a family
A membership almost always costs less than the visits and includes member lab and imaging pricing.
- Coverage and self-pay
You have a high-deductible plan
Self-pay prices are often below what the deductible would cost you; we will show you both figures.
- HSA and FSA information
You want to use HSA or FSA funds
Many care costs are HSA/FSA eligible; membership dues may not be.
Why paying cash per visit usually costs more than it looks
A single cash-pay office visit is rarely the end of the bill. A visit that turns up a blood pressure reading needs a follow-up. A symptom that needs blood work adds a lab charge, and often a separate draw fee. A rash that needs a second look means a second visit fee. People without coverage learn to wait, and waiting is what turns a $19.99 question into an urgent care bill.
Membership changes the arithmetic in one specific way: the ongoing part becomes predictable. Asking a question, following up on a result, or checking whether something needs to be seen is no longer a purchase decision. That is the practical value, and it is the honest case for it — not a promise that membership is cheaper than every alternative for every person.
Predictable monthly cost
One membership price, billed monthly. Included virtual care carries no copay and no per-visit fee.
Prices before you commit
Labs, imaging and in-person visits are quoted up front, so you can decide with the number in front of you.
No claims, no surprise EOB
Presence does not bill insurance for membership care, so there is no claim to be denied after the fact.
What is included, and what you still pay for
Included in membership
- Unlimited 24/7 virtual visits by phone or video, with no copay
- Ongoing primary care relationship: follow-up, medication review, preventive and wellness care
- Member pricing on labs, imaging and many common medications through participating partners
- Medically appropriate local primary care visits on Individual Unlimited and Family Unlimited
Not included
- Hospital, emergency room, surgical and specialty care
- In-office visits on the virtual memberships — $129 each on the $19.99 plan, or two included a year then $99 each on the $29.99 plan
- The one-time $49 clinical onboarding and medical history review before a first in-person visit
- Anything a separate facility bills you directly, such as an imaging centre or a laboratory
Membership is not health insurance. Prices shown are membership prices, billed monthly on a 12-month commitment.
How to work out whether it is worth it for you
Count last year honestly
Add up every urgent care visit, walk-in clinic visit, retail clinic visit and avoided appointment from the last twelve months. Include the ones you paid for and the ones you skipped.
Decide what you actually need access to
If you mostly need someone reachable for everyday problems and prescriptions, a virtual membership may be enough. If you want in-person primary care several times a year, an Unlimited membership usually costs less than paying $99 per visit.
Keep catastrophic coverage separate
Membership is for the everyday layer. Decide separately how you would pay for a hospitalisation, because membership does not do that job.
Ages 13 and up for local in-person primary care. Virtual care is for eligible patients located in Texas.
Questions people ask
Do I need insurance to become a member?
No. Membership is self-pay and does not require any insurance. If you do have coverage, you can keep it — it simply is not used for membership care.
Is this cheaper than a marketplace plan?
It answers a different question. A marketplace plan exists to protect you from catastrophic bills; membership exists to give you affordable, reachable everyday care. Comparing the two directly is misleading, and we will not pretend one substitutes for the other.
Can I use an HSA or FSA to pay the membership fee?
Rules for membership fees vary and change. Ask your plan administrator or tax advisor before assuming the fee is eligible — we cannot give tax advice.
What happens if I need something membership does not cover?
Your provider tells you plainly and helps you get to the right place, including referrals for specialty care or imaging. Those providers bill you or your plan separately.
Is there a contract?
Membership is a 12-month commitment billed monthly, and continues month to month afterwards. The material terms are shown next to every price.
Who provides the care?
Virtual visits are handled by licensed providers. Local in-person primary care at Presence is provided by a board-certified Adult-Gerontology Primary Care Nurse Practitioner — a licensed clinician who diagnoses, treats, orders and interprets tests and prescribes within her scope of practice. She is not a physician, and we say so plainly.
About this information
Written by the Presence care team for patients considering care with us. Presence care is delivered by licensed providers, including a board-certified Adult-Gerontology Primary Care Nurse Practitioner — not by a physician, and not by software. Meet your provider.
This page explains how our service works. It is general information, not a diagnosis, and it is not a substitute for an evaluation of your own situation. Whether testing, treatment or a prescription is appropriate is decided during a visit.
If this is an emergency — chest pain, trouble breathing, stroke symptoms, severe bleeding, or thoughts of harming yourself — call 911 or go to the nearest emergency department. See our emergency care notice.
Care you can afford before it becomes urgent
Join Presence, or call and we will tell you honestly whether membership fits your situation.