Josh Umbehr Opened Atlas MD on $10,000. Now He's Watching Patients Drop Insurance Mid-Year.

People aren’t waiting for open enrollment. In 2026, some are dropping their health insurance mid-year because the monthly premium became more than they could carry.

That’s what Josh Umbehr is seeing at Atlas MD, his direct primary care practice in Wichita. In a Medical Economics interview published May 28, he described patients quitting their insurance mid-cycle and finding their way to a DPC practice as the most financially workable option left. Once they drop the premium, Umbehr said, they become “instantly hundreds or thousands of dollars richer every month.”

These patients arrived differently than the ones DPC has historically attracted. They didn’t research the model for months or land there by way of a podcast. They ran out of room in their budget.

Umbehr knows DPC from the ground up. He co-founded Atlas MD in Wichita in 2010, when the model was obscure enough that most physicians had never heard of it. The Medical Economics profile is part of the publication’s extended coverage of DPC as a practice path, and it covers territory that physicians new to the model tend to want answered first: what does starting a DPC practice actually cost?

How Little You Actually Need

Umbehr’s answer is about as low as it gets. Asked what he’d buy if starting a DPC practice with $10,000, he named three things: an EKG machine, a pill counter and a vitals machine. Everything else, in his view, is optional.

That framing cuts against the common assumption that opening a medical practice requires six figures in upfront capital. Traditional fee-for-service practices do require it, because the billing infrastructure alone is substantial: credentialing, clearinghouses, coding staff, denial workflows. DPC doesn’t carry that overhead. There’s no insurance billing apparatus to build.

A DPC practice with 400 to 800 members paying typical membership rates of $70 to $100 per month, according to DPC Frontier practice data, generates recurring revenue without patient visit volume driving income. The membership model changes what you need on day one, because the revenue structure is different from traditional primary care.

The 2026 Insurance Calculation

What’s new this year is the affordability pressure. ACA premiums have risen sharply in several markets, and for individuals and small business owners who’ve been in plans they could barely afford, the math is cracking.

The mid-year dropout Umbehr describes is someone who makes that calculation and decides a DPC membership at $70 to $100 a month for primary care with same-day access and no per-visit fees is manageable in a way that a monthly premium has stopped being. Especially when DPC can pair with a catastrophic plan or health-sharing arrangement for major expenses.

That’s not a new argument for DPC. What’s new is the urgency. These patients aren’t exploring alternatives. They’re making fast decisions under real financial pressure.

A Three-to-Five Year Prediction

Umbehr told Medical Economics he expects insurance-free primary care to become the default model, or at least the assumed one, for a lot more people within three to five years. His read is that rising premiums and improving direct-pay access will push more people to stop treating insurance-covered primary care as the obvious starting point.

Whether that timeline holds is uncertain. DPC has been called “about to break through” for years. But the growth data has started to back the claim. Hint Health’s 2026 Trends Report put DPC membership growth at 837% since 2017. Employers now fund 60% of active memberships. The model isn’t niche anymore, and the mid-year insurance dropout is one of the dynamics Umbehr thinks will accelerate the next phase.

What This Means

For physicians considering DPC, the $10,000 startup framing matters. The institutional medical culture tends to frame practice ownership as expensive and risky. Umbehr’s version of the story is different: minimal required equipment, no insurance billing infrastructure and recurring membership revenue from day one. That’s a different risk profile than a traditional practice launch.

For existing DPC practices, the mid-year dropout patient is a new type of enrollment event to plan around. These patients make decisions quickly and need a clear explanation of what they’re paying for and what they’re not. Practices that can answer the “what about emergencies?” question fast will convert more of them.

Umbehr has been in DPC long enough to have seen it dismissed, debated and slowly validated. His current read is that the timing has shifted. The patients showing up in 2026 aren’t just the ones who found DPC after years of frustration with insurance. Some are just people who ran the numbers and ended up at the door.