Maryland

Key Provisions

• **No Insurance Law Exemption:** Without a specific DPC law, direct primary care agreements are not explicitly exempt from Maryland's insurance code. This creates a risk that the Maryland Insurance Administration (MIA) could classify a DPC membership as an unlicensed insurance plan, as it involves a prepayment for future, uncertain healthcare needs. Practices must carefully craft agreements as contracts for services, not risk transfer, to avoid this classification.
• **Reliance on General Contract Law:** DPC practice viability hinges on meticulously drafted patient agreements. These contracts must clearly delineate the specific scope of primary care services included for the monthly fee, list services that are excluded (e.g., hospitalization, specialist care), and contain an explicit disclaimer stating that the agreement is not a health insurance policy.
• **Federal HSA and FSA Compatibility:** Following a federal change effective in 2026, patients in Maryland can use Health Savings Account (HSA) and Flexible Spending Account (FSA) funds to pay for DPC membership fees. The law permits up to $150 per month for an individual or $300 per month for a family. It is crucial to note this is a federal tax clarification and does not provide any state-level legal protection or alter Maryland's insurance regulations.
• **Standard Physician Oversight:** DPC physicians are licensed and regulated by the Maryland Board of Physicians, just like all other doctors in the state. They must adhere to the same standards of care, maintain proper medical records, and practice within their established scope of licensure. The DPC model itself is not specifically addressed by the Board, so its permissibility is based on general physician practice authority.
• **Patient Responsibility for Major Medical Coverage:** Because DPC is not insurance, practices must advise patients to secure and maintain a separate, comprehensive health insurance plan. This supplementary coverage is essential for medical needs outside the scope of primary care, including emergency services, hospital stays, surgical procedures, and specialist consultations. This disclosure is a critical component of patient education and informed consent.

Medication Dispensing

In Maryland, physicians are permitted to dispense medications directly to their patients from their offices, a practice commonly utilized by DPC clinics to enhance patient convenience and affordability. This authority is granted under the Maryland Health Occupations Article §12-505. To do so, a physician must register with the Maryland Board of Physicians and comply with all associated regulations, which include proper labeling, packaging, and record-keeping for all dispensed drugs. DPC practices typically leverage this ability to provide common, non-controlled generic medications at or near wholesale cost, eliminating the need for a separate trip to the pharmacy for routine prescriptions. However, they must adhere strictly to the state's dispensing guidelines to avoid functioning as an unlicensed pharmacy.

Medicaid Provisions

Maryland's Medicaid program, known as the Maryland Health Connection, does not currently have any provisions for integrating with or covering Direct Primary Care memberships. Consequently, DPC practices in the state cannot bill Medicaid for their membership fees, and services included under the DPC agreement cannot be billed to Medicaid. This creates a financial barrier for Medicaid recipients, as they would be required to pay the full DPC membership fee out-of-pocket in addition to their existing Medicaid coverage. There are no known pilot programs or waivers in Maryland aimed at exploring DPC as a potential model for the Medicaid population.