I read Explanation-of-Benefits letters for a living, so let me do the thing the industry hates: put real numbers next to each other.
The family
Two adults (38 and 40), two kids (7 and 11). A normal-use year: six sick visits across the household, two urgent-care-worthy incidents, both adults get physicals with labs, one kid needs a sports physical, one adult takes two generic medications daily.
Option 1 — the "good" copay PPO
Portland-market family premium for a low-deductible PPO runs roughly $1,900/month if you buy it yourself (employer plans hide this, but the money is still yours — it is wages you never see). Add $35 copays, $60 specialist copays, lab bills that arrive six weeks later with numbers nobody can explain. Cash leaving the household: ~$23,500/year.
Option 2 — HDHP alone
A bronze-tier HDHP for the same family: roughly $1,150/month. The deductible is scary ($9,200 family), so every sick visit becomes a negotiation with yourself. Six PCP-level visits at self-pay rates (~$165 each), two urgent care runs (~$195), retail labs, retail generics. Cash leaving: ~$16,100/year — if nobody gets seriously sick, and if you actually go when you should. The dangerous part is the "if": deductible fear delays care.
Option 3 — HDHP + Fernwell
Same HDHP as the safety net ($1,150/month). Fernwell for the family: $79 + $109 + $39 + $39 = $266/month (under our $299 household cap, so $266 it is), plus the one-time $99 enrollment. All six sick visits, both physicals, the sports form, the stitches on a Saturday: $0 extra. Labs for two adult panels: about $31 total at cost. Two generics year-round from the wholesale shelf: about $42 for the year. Cash leaving: ~$17,200/year — with none of the deductible fear, because primary care is already paid for.
So option 2 is cheaper?
On this spreadsheet, by about $1,100 — and we would still argue option 3 wins, for a reason spreadsheets undercount: the HDHP-alone family rations its own care. They skip the visit that catches the blood pressure at 145 instead of at the ER. They stretch the inhaler. Our members text about the weird mole because it costs nothing to ask. Over a decade, that behavioral difference is the whole ballgame — and it is why the HDHP+DPC pairing, not DPC alone, is what we actually recommend.
Your household is not this household
Which is why the True-Cost Calculator exists — same assumptions, your numbers, nothing hidden. And the HSA caveat, because we promised honesty: under current IRS guidance DPC fees are generally not HSA-qualified, so talk to a tax person before paying the membership from that account.