Since January 1, 2026, Health Savings Account money can be used to pay for Direct Primary Care memberships — as long as the membership fee stays at or below $150 per month for an individual, or $300 per month for 2+ people in the household.
Why is this a big deal?
Two Laws That Contradicted Each Other
There were essentially conflicting laws up until this point.
The Affordable Care Act specifically defined Direct Primary Care as "not a health plan," but something that could be offered as part of a package on the health exchange. This was good.
The IRS, however (who made the laws regarding Health Savings Accounts), ruled that Direct Primary Care is a "health plan," and that any person who is enrolled in another "health plan" alongside a High Deductible Health Plan would not be eligible to contribute to a Health Savings Account.
What did that mean? Not only could you not use HSA dollars to purchase a DPC membership — you couldn't even have a Health Savings Account (or at least contribute towards one) if you had a DPC membership.
Finally this has been fixed. As of January 1, 2026, HSA dollars can be used to purchase a DPC membership.
Are There Limitations?
Yes, a few. Your membership has to qualify as what the law calls a "direct primary care service arrangement":
- The fee can't exceed $150/month for an individual, or $300/month if membership includes more than one person
- Labs cannot be included as part of the membership (other than those "typically administered in an ambulatory primary care setting")
- Medications (outside of vaccines) cannot be included as part of the membership
- Procedures that include the use of general anesthesia cannot be included as part of the membership
One important nuance on the $150 / $300 amounts: they aren't a cap on how much of your membership a patient can pay from their HSA. They're the threshold that decides whether your membership counts as disqualifying coverage — meaning whether your patient can contribute to an HSA at all while being a member of your practice. If your membership is priced above $150/month, the question isn't "can they pay me with HSA money," it's "does being my patient cost them their HSA eligibility." That's worth understanding precisely before you talk pricing with a patient who's on a high deductible plan.
What the IRS Clarified (Notice 2026-05)
The law left room for further guidance, and it arrived in late December 2025: IRS Notice 2026-05. A few things worth knowing.
It defines who counts as a primary care practitioner: physicians (MDs or DOs) in family medicine, internal medicine, geriatric medicine, or pediatric medicine — plus nurse practitioners, clinical nurse specialists, and physician assistants. If your practice is built around a provider outside that list (for example, a Naturopath), it's worth confirming how your arrangement is treated.
It also confirms the $150 / $300 amounts hold for 2026, with inflation adjustments starting in 2027. The first adjustment has already been published, and the figures didn't move — they're still $150 and $300 for 2027.
Treasury and the IRS took public comments on the notice through March 6, 2026, so additional guidance is still possible. I'll do my best to stay updated and post any changes here in this blog.
What This Means for Your Practice
Here are a couple ideas.
First — any patients who currently have an HSA account should be paying for membership out of that account. Why? They contribute to that HSA tax-free (usually through their employer or paycheck), and then get to pay for your membership with that tax-free money. Basically their money goes further.
Also, if you've spoken to any employer groups who are not yet members of your clinic but you know they have a high deductible health plan for their employees with an HSA — reach out and ask to present to their employees now that employees can pay for your membership with their HSA account.
Lastly, consider reaching out to larger businesses that may not consider membership at your clinic, but may allow you to present your membership as an option for their employees to use with their HSA money.
Want to read it for yourself? Here's the official text of the law, and the IRS announcement of Notice 2026-05, which links the full notice.
Please remember: I'm not a tax attorney or a CPA. This is my read of the law and the guidance as someone who works with DPC practices, not tax or legal advice. Before you build pricing or an employer pitch around it, run it past a knowledgable CPA or tax attorney.
Not sure how to word all this for your patients? I've put together example letters you can send to patients and employer groups.
