HSA-eligible patients and the Direct Primary Care (DPC) community have been caught in a regulatory "Catch-22" for more than ten years. In the past, if you had both an HSA and a High Deductible Health Plan (HDHP), the IRS considered your DPC membership to be "disqualifying coverage"—basically, a second health plan—which prevented you from making contributions to your HSA.
At last, that obstacle has been removed. The regulations were altered by the One Big Beautiful Bill Act (OBBBA), which was passed in July 2025, and the IRS guidance that followed in Notice 2026-5. Everything you need to know about the new era of Direct Primary Care that is compatible with the HSA is provided here.
On July 4, 2025, the 119th Congress passed the OBBBA, a comprehensive federal law. Its healthcare provisions constitute the most substantial update to Health Savings Account (HSA) law since the accounts were established in 2003, despite the fact that it covers a wide range of tax and spending policies, such as Medicaid work requirements and tax inflation adjustments.
For the purposes of HSA eligibility, qualified DPC memberships are no longer regarded as disqualifying "health plans" due to the act's official reclassification. Rather, they are acknowledged as a primary care service arrangement that can coexist with an HDHP.
The OBBBA offers DPC patients two significant benefits starting on January 1, 2026:
Contribution Qualifications: As long as you are otherwise HSA-eligible, taking part in a qualified DPC arrangement does not prevent you from making tax-deductible contributions to your HSA.
Expenses that qualify: The term "qualified medical expenses" now refers to DPC membership fees that are paid on a monthly or periodic basis. This implies that you can pay your doctor's monthly fee tax-free with your HSA funds.
The new law does not apply to all membership-based medical practices. A Direct Primary Care Service Arrangement (DPCSA) must fulfill certain federal requirements in order to be HSA-compatible:
A. The fee cap of $150 or $300
If a patient wants to continue being able to contribute to an HSA, the law places stringent restrictions on what a practice can charge:
B. Described "Primary Care" Services
The arrangement must only include "medical care consisting of primary care services" from "primary care practitioners" in order to be eligible. In this particular context, the IRS expressly excludes the following from the definition of primary care:
In an ambulatory primary care setting, laboratory services are not usually provided.
C. Avoid Double-Billing
The only payment for the care given within the membership must be a DPCSA. It is not permissible for a practice to charge a membership fee and then bill the patient or their insurance for the same primary care services covered by that arrangement.
The OBBBA's permanent extension of the Telehealth Safe Harbor, which previously permitted HDHPs to pay for virtual care prior to the deductible being satisfied, is among its most immediate advantages.
Retroactive to January 1, 2025: For plan years starting after December 31, 2024, there is no coverage gap because the OBBBA extends this relief retroactively.
Notice 2026-5 clearly distinguishes between DPC and more expensive Concierge models:
The following actions should be taken by stakeholders as the 2026 effective date draws near:
Disclaimer: This article does not provide legal or tax advice; it is merely meant to be informative. Regarding your particular circumstances, please speak with a qualified tax expert or benefits coordinator.
