Why are more medical practices thinking about dropping insurance?

The math has gotten worse. The American Medical Association reports that Medicare physician payment declined 33 percent from 2001 to 2025 once you adjust for inflation, while the cost of running a practice rose 59 percent over the same period. Add the paperwork, with physicians handling an average of 39 prior authorizations a week per the AMA, and many owners feel they work harder every year to earn less. Going cash pay, direct primary care, or concierge is one way to escape that squeeze.

Will I lose most of my patients if I stop taking insurance?

Some will leave, and you should plan for that. But the practices that transition well do not rely on their old panel staying put. They build a steady flow of new patients who are looking for exactly what a cash model offers, more time with the doctor and clear pricing. The deciding factor is almost never the clinical care. It is whether you can market yourself well enough to keep the schedule full without an insurer sending you patients.

What types of practices do best off insurance?

Models built around time and relationship tend to work best, such as direct primary care with a monthly membership, concierge medicine, and practices in areas patients already expect to pay for out of pocket like med spas, hormone and TRT clinics, weight loss, fertility, and aesthetics. The common thread is a clear value a patient can understand and a price they can see before they book.

How do I market a practice that does not take insurance?

You replace the insurer's referral pipeline with your own. That means a website that explains your model and pricing plainly and lets patients book, strong local SEO and a Google Business Profile so cash pay patients find you when they search, and targeted ads on Google and Meta aimed at the people most likely to pay out of pocket. When the insurance network stops feeding you patients, your marketing has to, so it has to be built before you make the switch, not after.

Should You Stop Taking Insurance?

Q: Is direct primary care actually growing?

Yes, and fast. The 2026 State of Direct Primary Care report counted more than 2,800 DPC practices across all 50 states, and Hint Health reported that DPC membership grew 837 percent from 2017 to 2025. For the first time, employers now fund the majority of active memberships. It has moved from a fringe idea to a real segment of primary care.

A healthcare provider reviewing insurance paperwork with a patient at a medical practice — For a lot of independent practices, the insurance relationship now means more paperwork for less pay. That is why the question keeps coming up. Photo via Pexels.

Let us start with why this question stopped being fringe. According to the American Medical Association, Medicare physician payment declined 33 percent from 2001 to 2025 once you adjust for inflation. Over that same stretch, the cost of actually running a practice rose 59 percent. Rent, staff, supplies, software, all up, while the main thing you get paid stayed flat or fell. Physicians are the only type of Medicare provider without an automatic annual update for inflation, and 2025 marked the fifth straight year of cuts. You can read the AMA's own breakdown of why Medicare physician pay has plummeted since 2001.

Then there is the paperwork. The AMA's 2024 prior authorization survey found physicians complete an average of 39 prior authorizations a week and spend around 13 hours on them, with 93 percent saying the process delays patient care and 89 percent saying it adds to burnout. So the doctor on our call was not imagining it. She really was working harder to earn less, and a good chunk of her payroll existed just to argue with insurers. When that is the daily reality, dropping insurance stops sounding radical and starts sounding like relief.

33% drop in Medicare physician payment from 2001 to 2025 after adjusting for inflation, even as the cost of running a practice rose 59 percent, per the American Medical Association.

What stopping insurance actually means

This is not one decision, it is a few different ones, and lumping them together is where owners get confused. The most common paths look like this.

Going fully out of network. You stop contracting with insurers and bill patients directly. Many still give patients a superbill to seek their own reimbursement, but you are paid up front.
Direct primary care. Patients pay a flat monthly membership, often somewhere around 80 dollars, that covers most primary care. No insurance billing at all for your services.
Concierge medicine. An annual or monthly fee for enhanced access and longer visits, sometimes alongside insurance for certain services.
Cash pay by design. Common in med spas, hormone and TRT clinics, weight loss, fertility, and aesthetics, where patients already expect to pay out of pocket.

Each one trades the insurer's steady, low paying patient flow for something you control, and for a model patients can understand at a glance. The appeal is obvious. More time per patient, clear pricing, and no third party deciding what your care is worth.

It is really working for a lot of practices

This is not wishful thinking. The 2026 State of Direct Primary Care report counted more than 2,800 DPC practices across all 50 states, and Hint Health's 2026 Direct Primary Care Trends Report found that DPC membership grew 837 percent from 2017 to 2025. For the first time, employers now fund the majority of active memberships, which tells you this is no longer a few idealistic doctors. It is a real and growing part of how Americans get primary care.

We see the same pull in the cash pay world every day. A TRT clinic or a med spa does not wait on an insurer to approve anything. It sets a price, markets the service, and books the patient. That simplicity is exactly why those practices tend to grow faster and stress less about reimbursement politics.

The part most people skip

Here is what we told the family medicine doctor, and it is the uncomfortable truth. When you stop taking insurance, you also unplug from the one thing insurance quietly did for you. It sent you patients. Being in a network put your name on lists, in directories, and in front of people searching for a doctor who takes their plan. That pipeline is not glamorous, but for a lot of practices it is the reason the waiting room is full.

Cut that cord and you are now responsible for every single new patient. No network to lean on. The practices that make the leap and thrive are not the ones with the best clinical story. They are the ones who can reliably bring in patients on their own. The ones that struggle almost always made the switch first and thought about marketing second, then watched the schedule thin out faster than the new model could fill it. If your practice is already too dependent on referrals to survive, dropping insurance will expose that overnight.

837% growth in direct primary care membership from 2017 to 2025, per Hint Health's 2026 report, with employers now funding most active memberships. The model works. The question is whether you can keep it full.

What has to be true before you make the move

We never tell a practice to drop insurance. That is a clinical and financial decision only the owner can make, often with an accountant in the room. What we do is tell them, bluntly, whether their marketing is ready to carry the weight it is about to inherit. A few things have to be in place first.

A website that sells the model, not just lists services. A cash pay patient needs to understand what they get and what it costs in under a minute, then book. Vague pages that hide pricing kill a cash model. This is the difference between a brochure and a website built to convert the right patient.
Local search that actually finds you. When someone types your specialty near them, or asks an AI chat for the best option, you need to show up. Strong local SEO and a clean Google Business Profile replace the directory listings the insurer used to give you.
A way to reach people who already pay out of pocket. Targeted ads on Google and Meta let you put your offer in front of exactly the patients most likely to say yes to cash pay. We cover the broader playbook in how to attract cash pay patients.
A plan for the patients you keep. Some of your current panel will stay if you make the value clear. Our guide on keeping patients when you drop insurance walks through how to have that conversation.

The theme across all of it is the same. Insurance was a growth engine you did not own. To let it go safely, you need a growth engine you do own, and it needs to be running before you flip the switch.

How EtherealMinds helps practices make the jump

When a practice comes to us weighing a move off insurance, we build the demand side so the decision is not a leap of faith. That starts with a patient acquisition system designed for your model, whether that is direct primary care, concierge, or a cash pay specialty. We build the website that explains your pricing and books patients, the search presence that makes you easy to find, and the Google and Meta ads that bring in people already comfortable paying out of pocket. For a deeper look at a membership model specifically, we wrote a full guide on marketing a direct primary care practice and another on marketing a concierge practice.

We also make sure you never lose the new patients your marketing earns. When a cash pay patient calls or fills out a form, the response has to be fast and human, because these patients are shopping and comparing. If your front desk is slammed or it is after hours, our AI receptionist answers, explains your model, quotes your pricing, and books the visit so a ready to pay patient never slips away.

The bottom line

Should your medical practice stop taking insurance? Maybe. The financial pressure is real, the alternatives are proven, and plenty of owners are happier and more profitable on the other side. But the decision does not hinge on how good your care is. It hinges on whether you can fill your own schedule without an insurer doing it for you. Get that engine built and running first, and dropping insurance goes from a scary gamble to a confident step. Skip it, and even the best clinical practice can run out of patients. Build the demand, then make the call.

Thinking about going cash pay or out of network?

Book a free strategy call and we will give you a straight answer on whether your marketing could carry the practice without insurance feeding it patients. We will look at your website, your local search, and where your new patients come from today, then show you exactly what would need to be in place first. Honest, specific, no pressure.

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