Key Takeaways
- DPC membership fees can now be paid with HSA funds. Qualifying direct primary care arrangements can be paid for with HSA funds, subject to federal requirements.
- Not every DPC or concierge arrangement qualifies. The federal rules establish specific requirements for the services provided, practitioners involved, and membership fees.
- Physicians should review their membership model. Practices offering DPC or concierge services should evaluate their agreements, pricing, services, and marketing before representing membership fees as HSA-eligible.
Why This Matters for DPC Physicians
Patients enrolled in certain direct primary care (DPC) arrangements can use Health Savings Account (HSA) funds to pay their membership fees. The change also allows an otherwise HSA-eligible individual to remain eligible to contribute to an HSA while enrolled in a qualifying DPC arrangement.
For physicians operating or considering a DPC practice, the change creates a significant opportunity. However, it also raises important questions about how membership arrangements are structured, priced, and marketed. Not every DPC or concierge medicine arrangement automatically qualifies under the new rules.
What Changed for DPC Practices in 2026?
The One Big Beautiful Bill Act changed the federal tax treatment of certain direct primary care arrangements.
Before the change, the IRS could treat a DPC arrangement as disqualifying health coverage for someone who otherwise had a qualifying high-deductible health plan (HDHP). That meant enrolling in a DPC arrangement could affect the individual’s ability to contribute to an HSA.
The new law creates an exception for qualifying DPC service arrangements. An otherwise eligible individual enrolled in a qualifying DPC arrangement can contribute to an HSA, and HSA funds can be used tax-free to pay the arrangement’s periodic fees.
For physicians, this makes DPC membership potentially more attractive to patients who use HSAs and may make the model more competitive with traditional fee-for-service primary care.
But the new rules do not apply to every membership-based medical practice.
What Is a Qualifying DPC Arrangement?
Federal law defines a qualifying Direct Primary Care Service Arrangement (DPCSA) based on the services provided, the practitioners providing them, and how the arrangement is structured.
Generally, the arrangement must provide only primary care services for a fixed periodic fee. Qualifying practitioners include physicians practicing family medicine, internal medicine, geriatric medicine, or pediatrics, as well as nurse practitioners, clinical nurse specialists, and physician assistants.
The definition of primary care services also has limits. It does not include procedures requiring general anesthesia, prescription drugs other than vaccines, or laboratory services that are not typically administered in an ambulatory primary care setting.
Physicians should look at the actual services included in their membership agreements rather than assuming that a practice qualifies simply because it calls itself a DPC practice.
The New Rules Set $150 and $300 Monthly Limits
One of the most important aspects of the rules is the monthly fee limitation. For purposes of determining whether a DPC arrangement qualifies as permitted coverage alongside an HSA-eligible HDHP, the aggregate fees for DPCSAs generally cannot exceed $150 per month for an individual or $300 per month for an arrangement covering more than one individual. Those amounts are subject to annual inflation adjustments.
This creates an important distinction for physicians. Exceeding the applicable monthly limit does not necessarily mean that the membership fee can never be reimbursed from an HSA. IRS guidance explains that fees for a DPC arrangement can still be treated as qualified medical expenses even when the arrangement exceeds the monthly limit.
However, the higher-fee arrangement can disqualify the individual from making HSA contributions while enrolled. In other words, HSA reimbursement eligibility and eligibility to contribute to an HSA are related but separate questions. That distinction is particularly important when physicians are designing or revising membership pricing.
DPC Is Not Necessarily the Same as Concierge Medicine
Physicians should also be careful about using “DPC” and “concierge medicine” interchangeably.
Concierge medicine can take several different forms. Some practices charge a membership or retainer for enhanced access to a physician while continuing to bill insurance for medical services. Other practices operate on a cash-pay basis and include primary care services as part of a recurring membership fee.
The federal DPCSA rules focus on the structure and substance of the arrangement, not the label a practice uses to describe it. A membership arrangement that includes services outside the federal definition of primary care, charges additional fees for covered services, or uses a billing structure inconsistent with the DPCSA requirements may not qualify.
Physicians considering a concierge model should determine whether their arrangement fits the federal DPCSA definition before advertising the membership as HSA-compatible.
The HSA changes may affect how you structure your membership fees, services, and patient agreements. Jackson LLP can review your proposed or existing model and identify the legal considerations before you launch or make changes. Book a free consultation with our team today.
What Should Physicians Review Based One Big Beautiful Bill Act?
The changes give DPC practices a reason to take another look at their membership structure. Practices considering HSA eligibility should review several components of their model, including:
Membership Agreement
The membership agreement should clearly identify what patients receive in exchange for the recurring membership fee. The services included should be evaluated against the federal definition of primary care services.
Fee Structure
Physicians should confirm whether the recurring fee falls within the applicable federal limits, particularly if preserving the patient’s ability to contribute to an HSA is part of the practice’s value proposition.
Practices should also be careful about separate charges for services that are represented as being included in the membership.
Billing and Insurance
A practice that combines membership fees with traditional insurance billing needs to examine how those arrangements interact.
A DPC practice and a concierge practice may look similar from a patient’s perspective while having materially different legal and tax implications. The way the practice collects fees and bills for services matters.
Marketing Materials
Website copy, enrollment materials, FAQs, and patient communications should accurately describe HSA eligibility.
A practice should avoid broad statements such as “our membership is HSA-eligible” unless the arrangement has been reviewed against the applicable requirements. The federal rules apply to qualifying arrangements, not to every practice that uses a DPC or concierge label.
Patient Communications
Patients may understandably ask whether they can use their HSA to pay the membership fee. Practices should be prepared to explain the basic requirements without making individualized tax or financial representations.
The patient’s own HSA eligibility also matters. The DPC rules do not eliminate the other requirements an individual must satisfy to contribute to an HSA.
What Does the Change Mean for Physicians Considering DPC?
For physicians considering a direct primary care model, HSA compatibility may be an important consideration when designing membership pricing and services.
A qualifying arrangement can give patients another way to pay for their primary care membership while allowing otherwise eligible patients to continue contributing to their HSAs. That may make a DPC model more appealing to patients who want predictable primary care costs while maintaining an HDHP and HSA.
At the same time, physicians should not design a membership around HSA eligibility alone. The practice still needs an appropriate professional entity, membership agreement, fee structure, billing model, and compliance framework.
The federal changes are therefore best viewed as an additional consideration when structuring a DPC practice, not as a blanket exemption for concierge or membership-based medicine.
What Physicians Should Do Now
Physicians already operating a DPC practice should review their membership agreements, pricing, included services, billing practices, and marketing materials in light of the new federal rules.
Physicians considering launching a DPC or concierge practice should address HSA eligibility as part of the initial design of the membership model rather than trying to modify the arrangement after patients have enrolled.
If you operate or are considering a DPC or concierge practice, a healthcare attorney from Jackson LLP can review your membership structure, agreements, fees, and related legal considerations.
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Frequently Asked Questions About DPC Membership Fees and HSAs
Can Patients Use HSA Funds to Pay DPC Membership Fees?
Yes, HSA funds can generally be used to pay fees for a qualifying Direct Primary Care Service Arrangement. The arrangement must meet the federal requirements governing DPC services, practitioners, and fees.
Are All Concierge Medicine Memberships HSA-Eligible?
No. The federal rules apply to qualifying DPCSAs, not to every concierge or membership-based medical practice. Whether a particular arrangement qualifies depends on its services, practitioners, fee structure, and other requirements.
What Is the DPC Membership Fee Limit?
For 2026, aggregate DPCSA fees generally cannot exceed $150 per month for an individual or $300 per month for an arrangement covering more than one individual for purposes of the special HSA contribution rules.
Can a Patient Still Use HSA Funds If a DPC Membership Exceeds the Monthly Limit?
Potentially. The monthly fee limit affects whether an arrangement qualifies for purposes of maintaining HSA contribution eligibility, while the treatment of DPC fees as qualified medical expenses is a separate issue. Physicians should not assume that exceeding the limit has only one consequence.
Can a DPC Physician Also Bill Insurance?
A physician may be able to combine membership-based care with insurance billing, but the legal and regulatory implications depend on how the arrangement is structured. Physicians should evaluate the relationship between membership fees, covered services, and insurance billing before launching the model.
Should Physicians Change Their DPC Membership Agreements?
Physicians should consider reviewing their membership agreements and related materials to determine whether they accurately reflect the practice’s services, fees, and HSA treatment. Any changes should be evaluated alongside applicable federal and state requirements.
