Enough to Make You Sick: 2027 Insurance Rates, and Straight Answers About Direct Primary Care

Oct 25

The numbers for next year's health insurance premiums are enough to make you ill, and I'll wager that illness is one of many things your insurer would rather not cover. In Arizona, individual-market premiums are going up almost 28%. In New Jersey, where my parents live, it's 19.8%. Nationally, the typical increase is about 15%.

Colorado is getting off a little easier, which is a strange thing to say about a double-digit increase. Here's what 2027 looks like for individuals and families here.

What's changing for individuals and families in Colorado

Premiums are up about 10% on average. The Division of Insurance finalized the 2027 rates in September. It varies by region: about 10.8% in the Denver area, 12% in the Boulder area (that's us in Longmont), and 15.5% in the Grand Junction/Mesa County region, the steepest in the state.
The federal subsidy cliff is back. The enhanced federal premium tax credits expired at the end of 2025, and Congress didn't renew them. Federal help now stops at 400% of the federal poverty level, which is $132,000 a year for a family of four. Earn a dollar more and you get no federal help at all.
Colorado is filling part of the gap, but less of it than this year. Colorado Premium Assistance is $80 a month for the first person in a household and $29 for each additional person in 2026. The state expects to lower that to $70 and $25 in 2027. With that help, the Division of Insurance estimates subsidized Coloradans will pay about $20 a month more next year. Without it, it would be about $69 more.
The worst-case bill gets bigger. The federal cap on out-of-pocket costs for marketplace plans rises to $12,000 for an individual and $24,000 for a family in 2027, up from $10,600 and $21,200. That cap is the most you'd pay in a bad year, on top of your premiums.

Open enrollment on Connect for Health Colorado starts November 1.

It's grim for employers, too

Small businesses: Small-group premiums in Colorado are rising about 14% on average in 2027, and about 15% in the Boulder area. That's steeper than the individual market.
Larger employers: Nationally, employers expect the cost of health benefits per employee to rise about 8% in 2027, even after cost-cutting changes to their plans. That's the biggest jump since 2003, according to Mercer's annual employer survey. With no changes, the figure is about 11%. Some of that gets absorbed. A lot of it reaches employees as higher paycheck contributions or bigger deductibles.
The "affordability" bar moved up. Under the ACA, an employer's plan counts as affordable in 2027 if the employee's share of the cheapest self-only plan is no more than 10.22% of household income, up from 9.96%. Family members get their own test: if adding them to the plan costs more than 10.22% of household income, they can turn down the employer plan and look for subsidized coverage on Connect for Health Colorado. The higher the percentage, the fewer families qualify for that exit.

The people behind the numbers

I keep meeting people whose plan for next year is to go uninsured. I keep meeting employers who can't see a way to offer health care to their teams. A business with fewer than 50 employees has no legal obligation to offer health coverage. That's hard on small businesses, and on the people who not only work for them but genuinely believe in them.

Here in Longmont I could name a dozen of those businesses without thinking about it. The owners care about their people. They also can't spend $9,000 a year to insure each employee, let alone $26,000 to cover their families. A little under half of Coloradans get their insurance through work. What happens when work can't provide it?

I believe the answer starts with good primary care. Not primary care on its own, but primary care as one part of a plan, alongside something affordable that keeps you out of bankruptcy if something terrible happens that you couldn't have planned for. For individuals, families and teams, I think Direct Primary Care is still the best way to get top-quality primary care.

I've written a lot about how Direct Primary Care feels: what leaving corporate medicine did for my creativity, my relationships with patients, and my ability to be present for my family. Today I want to be a bit more objective and put some plain facts on the table.

FAQ: Direct Primary Care at Metronome Family Medicine

These answers reflect my current practices and prices as of October 2026. Prices for labs, imaging and medications can change if my vendors change theirs.

What are the benefits of Direct Primary Care compared to traditional health insurance?

Direct Primary Care (DPC) isn't a replacement for insurance. It replaces the way insurance pays for primary care. You pay your doctor a flat monthly membership, and the copays, the waiting, the 15-minute visit limits and the billing codes go away. The benefits are practical:

You can reach your own doctor directly by phone, text, email or secure message.
You get same-day or next-day visits for problems that can't wait.
Visits are long enough to deal with more than one problem.
Visits have no copays, and there's no separate bill afterward.
You know the price of labs, imaging and medications before you agree to them.
You see the same physician every time.

That last one matters more than it sounds. A 2022 study of more than 4.5 million Norwegians found that people who'd had the same family doctor for 15 years or more were about 25% less likely to die during the study period than people who'd had their doctor for less than a year. They also needed about 30% less after-hours care and had about 28% fewer acute hospital admissions. That study is about continuity with one doctor, not DPC specifically, but continuity is exactly what DPC is built to protect.

What DPC doesn't do is pay for hospitals, emergencies, surgery or specialists. That's why I recommend pairing it with coverage for the big, unpredictable things (see "What is not included?" below).

And as of January 1, 2026, federal law lets you pay DPC membership fees from a Health Savings Account (HSA), up to $150 a month for an individual and $300 a month for a family. Having a DPC membership also no longer disqualifies you from contributing to an HSA.

What is included in the membership?

Memberships at Metronome Family Medicine include:

Direct access to your doctor by phone, text, email or secure message
Same-day or next-day weekday visits for acute problems when my schedule allows, by virtual visit or office visit
Unlimited office and virtual visits with no copays
One physician who gets to know you over time, so your care can be planned ahead rather than handled one crisis at a time
Everything a family doctor does, short of delivering babies or rounding in the hospital. I don't do those anymore.

That last item covers:

Preventive wellness exams: well woman, well man and well child visits
School, camp and sports physicals
Same-day sick visits for things like infections, rashes, injuries, allergies, flu and COVID
Chronic disease management, including but not limited to diabetes, high blood pressure, high cholesterol, asthma, COPD, hypothyroidism, irritable bowel syndrome, GERD, osteoarthritis and sleep apnea
Mental health care, including evaluation and medication management for depression, anxiety and ADHD when appropriate
Midlife care for perimenopause, menopause and andropause, which may include hormone replacement or testosterone therapy
Thyroid and metabolic health
Medical weight management, which may include GLP-1 medication
Body composition analysis with regular InBody scans, to track muscle mass and visceral fat as they actually change
Gender-affirming care
Prevention navigation and counseling, including age-appropriate cancer screening, skin cancer screening and total-body skin exams
Ordering and interpreting lab work when it's clinically relevant
EKGs in the office
Medication management and keeping track of refill schedules
Nutrition, exercise and smoking or vaping cessation counseling
End-of-life planning
In-office procedures when appropriate, such as ingrown toenail removal, ear wax removal, and removal of foreign objects from ears and noses
Care coordination with specialists, including virtual specialist consults for about $75, a fraction of the cost of a specialist office visit
House calls for members who live within 10 miles of the office, scheduled at least a day ahead when my schedule allows. There may be an additional fee.

Membership also gets you access to things that cost a lot more in conventional medicine:

Negotiated prices on imaging. On a high-deductible plan, an MRI at a hospital-based facility can cost $1,000 to $2,000 or more, and it can take weeks to get in. Through my practice, an MRI can be ordered and often performed the same day at a negotiated cash price of about $500.
Negotiated prices on labs. A hormone panel with estradiol, testosterone and progesterone measured by LC-MS (the more precise method) costs less than $80 through my lab partner, with other labs included for context. Ordered outside insurance through a direct-to-consumer lab, the same specialized tests can total $100 to $250 or more. With insurance, if the claim is denied or you haven't met your deductible, you can end up paying the full billed price.
Wholesale access to medications. With insurance, generic copays usually run $10 to $40 a month per prescription, or more before you meet your deductible. For someone on several maintenance medications, that's $50 to $150 a month. Many common generics cost a few dollars a month at wholesale. I stock some on site, and we can compare prices at the pharmacy of your choice.
Primary care procedures for the cost of materials. In fee-for-service medicine, freezing a wart is billed as a separate procedure. Removing a simple lipoma (a fatty lump under the skin) can cost hundreds to thousands of dollars, depending on where it's done. In my clinic, cryotherapy is included in your membership. If a simple lipoma is appropriate to remove in primary care, you pay only for materials, about $30 for lidocaine, a scalpel blade and some sutures, plus pathology if the tissue needs to be examined.

How much are membership fees, when are they billed, and what are the cancellation and refund terms?

Adults (18 and over): $149 a month
Kids (under 18): $125 a month, with at least one adult member in the household
Families: 10% off each additional family member when one adult pays full price
Paying a year up front: 5% off. You can also pay monthly, quarterly or every six months, at the full monthly rate.
Enrollment: a one-time $150 enrollment fee per household. That's a limited-time rate, so it won't last forever.
Employer groups: pricing is available for teams. See the employers page or give me a call or a text.

Fees are charged automatically, to the card, bank account or HSA card you keep on file, on the same day of each billing cycle. Memberships renew each year unless you cancel.

Cancelling: you can cancel at any time with 30 days' written notice. Email me and I'll send you the cancellation form. You remain a full member for those 30 days, including refills, and payments during the notice period aren't refunded. If you prepaid for a quarter, six months or a year, I refund the full months remaining after the 30-day notice period.

Other fees, so there are no surprises: $20 for an appointment missed or cancelled with less than 24 hours' notice. $25 if an automatic payment fails and isn't updated within a week. If you cancel and later rejoin, you pay any past-due balance plus a $150 re-enrollment fee.

What I ask of you in return: unless you're a virtual-only member, adult members come in person within 30 days of joining, sooner if you need refills or have a chronic condition. After that, I'll see you in person for a wellness visit every 12 to 18 months if you're 18 to 39, and every year from 40 on.

What is not included?

Hospital stays, emergency room visits, urgent care, surgery and specialist visits aren't included. Neither are screening tests done at outside facilities, like mammograms, colonoscopies and DEXA scans. I order them, coordinate them and help you find a good price, but the facility bills you or your insurance.

Also not included:

Outside labs and imaging. You pay my negotiated cash price or use your insurance.
Pathology. If a tissue sample needs to be examined, the pathology lab bills me at a price I've negotiated, and I bill you.
Medications
Vaccines. I'll tell you which ones you need and help you get them through a pharmacy or Boulder County Public Health.
Durable medical equipment, like boots, braces and slings.
DOT physicals, workers' comp visits, and disability evaluations for insurance or Social Security

For hospitals, emergencies and specialists, you'll want coverage alongside your membership. Options include a conventional high-deductible health plan, which covers preventive screenings; a health share plan, which isn't insurance and doesn't always cover screenings; or, for employers, a self-funded or level-funded health plan. If you don't have a good insurance broker, you're welcome to call mine. Ask me and I'll share their info :)

Can I join if I have Medicare or Medicaid?

Medicare: yes, I take Medicare patients. I've opted out of billing Medicare and other government health programs, so you can't submit my services to them for reimbursement. If you have Medicare Part B, you'll sign a Medicare private contract with me before your first visit. Medicare still covers your hospital care, specialists, imaging and everything else outside my office.

Medicaid: no. Colorado law doesn't allow me to enroll Health First Colorado (Medicaid) members.

How do you handle labs, imaging and prescriptions? Where do you send them, and what will I pay?

Labs go to Quest through my lab partner, Junction Health. I send you the order and tell you the price. You get the blood drawn when it suits you, and you're charged once the results come back, to the payment method on file for your membership. You can show your insurance card instead. But your insurer may decide not to cover the labs and bill you later, sometimes for more than my negotiated price. Once a lab has been billed to insurance, it can't be switched to the cash price afterward.

Imaging is usually done locally at Health Images in Longmont, where I've negotiated cash prices. You can use insurance, but that can mean a delay for approval, a denial, or a price higher than my negotiated rates. If you pay cash, you pay when the imaging is done.

Prescriptions can go to the pharmacy of your choice. I stock some medications on site, and you may be able to pick them up here at wholesale price. CostPlusDrugs.com also sells medications with minimal markup. We can use GoodRx together to find the lowest price, and your insurance may cover some prescriptions.

What are typical wait times for routine and urgent visits? Do you offer telehealth or after-hours care?

Routine visits are usually available within 7 to 14 days. For urgent problems, I aim for a same-day or next-day visit, depending on my schedule. Some of those visits will be virtual if that's the faster way to see you. New-patient visits and wellness exams are scheduled ahead, not same day.

I offer telehealth. In-person visits are Monday, Tuesday and Thursday from 9 am to 6 pm, with the last appointment at 5. Virtual visits are available Monday through Friday from 8 am to 5 pm, for members anywhere in Colorado. You'll need to be physically in Colorado during any virtual visit, because that's where I'm licensed.

I do my best to respond the same day to every call, text or secure message sent before 5 pm on a weekday. Anything sent after that gets a response the next business day. I'm not available on weekends or after hours. For anything that can't wait, use urgent care or the ER, or call 911.

Are there family medicine practices in Boulder County that offer same-day appointments?

Yes. Metronome Family Medicine, my Direct Primary Care practice in Longmont, offers members same-day or next-day weekday visits for acute problems, in person or by video, depending on my schedule. In-person visits are Monday, Tuesday and Thursday, and video visits are available Monday through Friday. I see patients from Longmont, the rest of Boulder County and southern Weld County, and virtual members from all over Colorado. Members can also text or call me directly, and if you reach me before 5 pm on a weekday, you'll hear back that day. Many Direct Primary Care practices are built to offer this kind of access. Keeping panels small is what makes it possible.

Where can I find a primary care physician in Longmont, CO who offers hormone therapy and weight management?

At Metronome Family Medicine in Longmont, hormone therapy and medical weight management are part of your primary care membership, not a separate program. That includes perimenopause and menopause care, testosterone therapy for men with hypogonadism, thyroid and metabolic care, and medical weight management that may include GLP-1 medication. Your hormone care, your weight care and the rest of your primary care are all handled by the same family physician, with no separate clinic and no separate membership. Labs and medications are billed at transparent prices.

How can I find a doctor who integrates metabolic and hormone care into primary care?

Look for a family physician or internist who treats hormones, weight, blood sugar, cholesterol, sleep and mood as one connected picture, rather than referring each one out to a different clinic. When you're choosing, ask:

Will the same doctor who manages my hormones also manage my blood pressure, cholesterol and cancer screening?
How do you decide whether hormone therapy is right for me, and how do you monitor it over time?
What labs do you use, what do they cost, and will you go over the results with me?
Do you track body composition, not just weight?
Is this an add-on program with its own fees, or part of my regular primary care?

In Direct Primary Care, the longer visits and direct access make this kind of integrated care practical. At my practice in Longmont, it's the core of what I do.

What should I consider when choosing a Direct Primary Care provider in Colorado?

Access. How quickly can you get seen when you're sick, and how do you reach the doctor? Get the answers in writing, and make sure the agreement matches what the website says.
What's included. A good DPC agreement lists the included services and anything that costs extra. Read it before you sign.
The full price. Ask about enrollment fees, family and annual discounts, cancellation notice, refund terms and no-show fees.
Labs, imaging and medications. Does the practice have negotiated cash prices? Does it share them up front?
Eligibility. Colorado DPC practices can't enroll Health First Colorado (Medicaid) members. If you have Medicare, ask whether the doctor has opted out of Medicare. If so, you'll sign a private contract before your first visit.
Telehealth. Virtual visits generally require you to be in Colorado at the time of the visit.
HSA use. As of 2026, DPC fees of up to $150 a month for an individual, or $300 for a family, can be paid with HSA funds. Check your household total and confirm with your HSA administrator.
Credentials. Look up the doctor's Colorado license on the state's DORA license lookup and check board certification with the relevant board, such as the American Board of Family Medicine.
Coverage for the big stuff. DPC is not insurance. Any Colorado DPC agreement should say that plainly. Plan for hospitals, emergencies and specialists separately.
Fit. You're choosing a person, not a network. Most DPC doctors, including me, offer a free meet-and-greet.

To find practices near you, try the DPC Mapper at mapper.dpcfrontier.com or the DPC Alliance at dpcare.org.

Is Metronome Family Medicine accepting new patients?

Yes, but space is extremely limited. I'm a solo physician and I keep the practice small on purpose, because a small practice is what makes same-day access, long visits and a doctor who actually knows you possible. I'm enrolling adults, kids and families in Longmont, Boulder County and southern Weld County, plus virtual-only members anywhere in Colorado, while spots last. The best first step is a free 15-minute consult to see whether we're a good fit.

How do you coordinate care with specialists or the hospital?

When I can, I bring the specialist to you virtually. A cardiologist can read a complicated EKG for about $35, and most other virtual specialist consults cost about $75. If you need to be seen in person, I can send a referral to the specialist of your choice. If that doesn't work, we'll find someone together who takes your insurance or whose cash price works for you.

You never need my permission to go to the ER. Plenty of patients contact me during business hours to ask whether they should. If you can't reach me quickly (maybe I'm with a patient) and you think you need emergency care, go. My office is not a substitute for emergency or urgent care.

Can you share your license, board certification and a sample patient agreement?

I'm licensed as a physician by the Colorado Medical Board, license DR.0055671. It's public record :) I'm board certified in family medicine by the American Board of Family Medicine, and the certificate hangs in my office. I'm also a Fellow of the American Academy of Family Physicians.

Here's my onboarding paperwork, so you can read everything before you sign anything:

Questions? Call or text 720-856-4058, or book a free consult.

Metronome Family Medicine is a Direct Primary Care practice. A membership is not health insurance and doesn't cover hospital, emergency, specialist or other care outside the practice.

Sources

Brian Juan