Direct primary care and HSA rules beginning in 2026
Check whether a direct primary care arrangement fits the statutory services and fee limits for HSA eligibility and payment.
Beginning in 2026, a qualifying direct primary care arrangement does not itself disqualify HSA contributions, and HSA funds may pay qualifying periodic fees within statutory limits.
Inspect the arrangement, not its label
Review provider type, primary-care services, excluded services, periodic fee, and whether broader insurance-like coverage is included. Concierge and membership programs do not automatically qualify.
Confirm the applicable fee limit
The law specifies indexed fee ceilings. Check official guidance for the year before paying from the HSA. Services outside the arrangement follow ordinary qualified-expense rules.
Example and common mistake
A clinic membership bundles primary care, specialists, and prescription coverage. Its name does not establish qualification. Reimbursing any medical membership without checking services and fees is the mistake.
Review the membership contract and fee
Identify every service included in the direct primary care arrangement and the monthly fee charged for each covered person. The 2026 rule uses statutory definitions and indexed fee limits. An arrangement that includes broader insurance-like benefits, specialists, prescription coverage, or services outside primary care may require a different conclusion.
Retain the contract, fee schedule, and payment record before treating membership fees as qualified HSA expenses. Also test the person's HDHP, Medicare, dependency, and other coverage for contribution eligibility. Qualification of the membership does not itself make the individual eligible to add money to an HSA.
Questions to resolve
- Does the contract stay within the statutory primary-care service definition?
- Is the fee within the applicable indexed limit?
- Does the arrangement bundle specialist, prescription, or insurance-like benefits?
Federal authority record
- IRS: New HSA tax benefits under the Working Families Tax Cuts
Effective dates and scope of the 2025 and 2026 HSA changes - IRS: Working Families Tax Cuts
Enacted HSA changes for telehealth, individual-market plans, and direct primary care - U.S. House Office of the Law Revision Counsel: 26 U.S.C. section 223 - Health savings accounts
HSA eligibility, contribution limits, qualified distributions, and beneficiary rules