Open enrollment in South Jersey: pairing direct primary care with your insurance
By Frank Aliganga, MD, FAAFP
Every fall, the same question comes up in our West Deptford and Old City offices: "If I have a doctor I can text, do I still need health insurance?" My answer is yes, and open enrollment is the right time to set things up so your membership and your insurance each do the job they're best at.
Here's a plain-language guide to the dates, the reasons we recommend keeping a plan, and some new rules that make health savings accounts (HSAs) work with direct primary care for the first time.
The dates to know
New Jersey (individual market, on or off Get Covered New Jersey): November 1, 2026 through January 31, 2027.
Pennsylvania (Pennie): November 1, 2026 through January 15, 2027. Enroll by December 15, 2026 if you want coverage to start January 1. Federal court cases have moved marketplace dates before, so confirm at pennie.com before you count on them.
Medicare: Medicare Open Enrollment runs October 15 through December 7. If you're on Medicare, use that window to review your options with Medicare or a licensed counselor.
Through work: Many employers hold their own open enrollment in the fall. Check with HR for your deadline.
Why we recommend keeping insurance
Empowered Health Direct Primary Care covers your everyday and ongoing care: visits, follow-ups, chronic condition management, and direct access to me by text, call, or the member app. There are no copays or per-visit fees, ever.
What a membership doesn't cover are the big, unpredictable things. That is exactly what insurance is for:
Emergency room visits and ambulance rides
Hospital stays and surgery
Specialist care, such as cardiology or orthopedics
Advanced imaging, such as MRI and CT scans
Think of it this way: your membership is for the relationship and the day-to-day, and your insurance is your safety net. When you need a specialist or a scan, I help you figure out where to go, what to ask, and how to make the most of your coverage.
What's new in 2026: your HSA and direct primary care
For years, being a member of a direct primary care practice could block you from contributing to an HSA. A 2025 federal law and IRS guidance (IRS Notice 2026-5) changed that, starting January 1, 2026. Here's what the guidance says:
Membership no longer blocks HSA contributions, as long as the arrangement qualifies and your total direct primary care fees are $150 a month or less for one person, or $300 a month or less when more than one person is covered. Those limits will be adjusted for inflation after 2026.
You can use HSA dollars to pay membership fees tax-free. The IRS treats qualifying fees as medical expenses.
Bronze and catastrophic marketplace plans now count as HSA-eligible plans, as long as the plan is available as individual coverage through an Exchange.
A few fine-print points: fees your employer pays for you can't also be reimbursed from your HSA, and if your fees go over the monthly limit, you can still use HSA money to pay them, but you can't contribute to an HSA while enrolled. If you have questions about your own situation, check with your HSA administrator or a tax professional.
How to choose a plan that fits
When your everyday care is handled by your membership, many people look for a plan built mainly for the big stuff. As you compare plans, ask yourself:
Is my hospital in network? Check the hospitals you would actually use in South Jersey or Philadelphia.
Are the specialists I see in network? If you see a specialist regularly, look them up before you pick.
What is the deductible and out-of-pocket maximum? This is what you would pay in a bad year.
Is the plan HSA-eligible? If you want to save pre-tax dollars, this matters more than it used to.
What do my prescriptions cost? Look up your regular medications in the plan's drug list. Members also have access to our transparent pricing on many medications, so bring your list and we can compare.
There is no single right answer. The best plan depends on your health, your budget, your family, and how much risk you're comfortable with.
We're here to help you think it through
I can't pick a plan for you, but I'm happy to talk through how your health needs fit with the options you're weighing. That's part of having a doctor who knows you.
If you're not a member yet and want to see how direct primary care could fit alongside your insurance, text us at 609-678-3299 to set up a free 15-minute Meet & Greet.
Educational, not medical advice. This is general information, not insurance or tax advice.
