A concierge or direct primary care membership may feel like an obvious healthcare expense. That does not automatically make the entire fee eligible for payment from a Health Savings Account (HSA) or Flexible Spending Account (FSA).
The rules changed for direct primary care (DPC) on January 1, 2026. People enrolled in certain qualifying DPC arrangements can now use HSA funds tax-free for the periodic membership fee. A qualifying arrangement priced at no more than $150 per month for one person, or $300 per month when it covers more than one person, also allows an otherwise eligible member to keep contributing to an HSA.[1]
Concierge medicine requires a different analysis. Many concierge practices charge a membership fee for access and longer appointments, then bill insurance for the medical visit. That structure usually does not meet the new federal definition of a qualifying DPC arrangement.[1]
The name on the practice website does not decide the tax result. The membership agreement, services, billing structure, and price do.
This article provides general educational information. HSA and FSA eligibility depends on federal tax rules, the membership contract, and your plan documents. Ask your plan administrator or tax adviser about your specific arrangement before taking a reimbursement.
The Short Answer
Here is the practical 2026 answer:
A qualifying DPC membership: You can use HSA funds for the periodic fee. If the total fee stays at or below $150 per month for individual coverage or $300 per month for coverage of more than one person, the membership will not by itself prevent new HSA contributions.[1]
A DPC membership above those limits: The fee may still qualify for payment from an HSA, but the membership can make you ineligible to contribute new money to the HSA while enrolled.[1]
A typical hybrid concierge membership: Do not assume the retainer qualifies. A practice that requires membership and also bills you or your insurance for the covered primary care services generally does not meet the special DPC rule.[1]
Separately billed medical care: Copays, diagnostic testing, and other qualified medical expenses may still be eligible under the ordinary HSA or FSA rules.[2][3]
An FSA: The 2026 DPC law created a specific HSA rule, not a blanket FSA rule. Your FSA can reimburse only expenses allowed by its plan, and the administrator may require detailed substantiation.[2]
For a broader explanation of how the two membership models work, see our concierge medicine vs. direct primary care comparison.
HSA and FSA Mean Different Things
An HSA belongs to you. You generally need qualifying health coverage to contribute new money, but the account remains yours if you change jobs or health plans. Tax-free withdrawals can pay qualified medical expenses for you, your spouse, and eligible dependents.[2]
An FSA is an employer-sponsored benefit. The employer's plan decides which permitted expenses it will reimburse, subject to federal rules. The plan can require documentation and can exclude an expense even when the expense might otherwise meet the federal definition of medical care.[2][4]
That creates two separate HSA questions:
Can I use money already in my HSA for this membership?
Can I continue contributing new money to my HSA while I have the membership?
The answer can be yes to the first and no to the second. This distinction matters most when a DPC fee exceeds the 2026 monthly limit.
How the 2026 DPC Rule Works
The Internal Revenue Service (IRS) calls the qualifying contract a direct primary care service arrangement. It must provide medical care consisting solely of primary care services in exchange for a fixed periodic fee.[1]
The arrangement must meet several conditions:
A primary care practitioner provides the care.
The fixed periodic fee is the sole compensation for the care included in the arrangement.
The arrangement provides only primary care services.
It does not include procedures requiring general anesthesia.
It does not include prescription drugs other than vaccines.
It does not include laboratory services that are not typically administered in an outpatient primary care setting.[1]
The IRS says physical examinations, vaccinations, urgent care, routine laboratory testing, and the diagnosis or treatment of some illnesses and injuries can fit within the arrangement.[1]
Billing frequency can be monthly, quarterly, semiannual, or annual. For 2026, a qualifying individual membership can charge up to $1,800 for the year and remain within the $150 monthly contribution-eligibility limit. The comparable limit for an arrangement covering more than one person is $3,600 for the year.[1]
The IRS also permits an HSA to reimburse a substantiated annual DPC fee at the start of the coverage period, even when the member prepaid before January 1.[1]
The $150 and $300 limits control contributions
The price limit applies to your ability to remain eligible for new HSA contributions. It does not create an absolute ceiling on paying the DPC fee from existing HSA funds.
Suppose one person joins a contractually qualifying DPC practice for $175 per month. The IRS says that fee can still be treated as an HSA-qualified medical expense. The higher fee, however, makes the person ineligible to contribute new money to the HSA during the months of enrollment.[1]
If you have more than one DPC arrangement, the IRS aggregates the monthly fees when applying the limit.[1]
The DPC membership also does not count toward your insurance deductible or annual out-of-pocket maximum. Your health plan did not cover that fee, so the IRS does not treat it as spending under the health plan.[1]
Most DPC practices in the NextMD directory charge $50 to $200 per month, or $600 to $2,400 per year. A practice can sit within the normal DPC price range and still exceed the $150 individual HSA-contribution limit. Price is only one requirement. Our article on what direct primary care costs to operate explains why the model can charge a predictable monthly fee without insurance billing.
Why Many Concierge Memberships Do Not Fit the DPC Rule
Concierge medicine commonly uses a hybrid billing structure. You pay an annual retainer for access, longer appointments, care coordination, and a smaller patient panel. The practice also bills Medicare or private insurance for covered medical visits.
The 2026 DPC rule requires the fixed periodic fee to be the sole compensation for the primary care included in the arrangement. IRS guidance says an arrangement does not qualify when members must pay a periodic fee to receive care and the practice also bills them or their insurance separately for that care.[1]
This makes a typical insurance-billing concierge contract different from a qualifying DPC contract.
Some concierge practices may operate on a fixed-fee, no-insurance basis that satisfies the federal DPC definition. A practice's use of the word “concierge” does not disqualify it. Likewise, the letters “DPC” in a practice name do not prove that its contract qualifies. Ask the practice to confirm the contract terms in writing.
Concierge fees usually range from $3,000 to over $40,000 per year. You can review the price tiers in our concierge medicine cost guide. At those prices, many concierge memberships exceed the DPC contribution-eligibility limit before the billing structure is considered.
Can You Use an FSA for DPC or Concierge Medicine?
There is no single yes-or-no answer for every FSA.
A health FSA generally reimburses qualified medical expenses allowed by the employer's plan. The IRS ties those expenses to the federal definition of medical care, including diagnosis, treatment, and prevention of disease. Expenses that benefit general health without providing medical care do not qualify.[2][3]
The plan administrator may require:
A receipt or statement from an independent third party
The date the expense was incurred
The amount paid
A description of the medical care
Your certification that no other health plan reimbursed the expense[2]
An FSA cannot reimburse projected future expenses in advance.[2] If a practice charges one annual fee, ask the FSA administrator whether it will reimburse the expense when paid, monthly as care becomes available, or only after itemized services occur.
An IRS Chief Counsel letter about a medical concierge fee illustrates the plan-specific problem. The patient paid an annual fee for greater physician access, a comprehensive physical, longer visits, and access to dietitians and exercise therapists. The reimbursement plan denied the fee. The IRS explained that an expense must meet the federal definition of medical care and the plan's own reimbursement rules. A plan may choose not to reimburse an expense even if the expense otherwise qualifies as medical care.[4]
Get approval from the FSA administrator before relying on reimbursement. A practice's statement that a fee is “FSA eligible” does not bind your employer's plan.
Four Common Membership Examples
Membership structure | HSA payment | New HSA contributions | FSA treatment |
|---|---|---|---|
$100/month qualifying DPC contract for one person | Yes | Generally permitted if you otherwise qualify | Ask the plan administrator |
$175/month qualifying DPC contract for one person | Yes | Disallowed during enrollment months | Ask the plan administrator |
$4,000/year concierge retainer plus separate insurance billing for member visits | Do not assume the special DPC rule applies | Contract may create an HSA eligibility issue; verify | Plan-specific, documentation required |
$125/month fixed-fee primary care contract marketed as “concierge,” with no separate billing for included care | May qualify if every DPC requirement is met | May remain permitted | Ask the plan administrator |
These examples show why the contract matters more than the marketing label.
When to Request an Itemized Receipt
Request documentation before you submit a large concierge or DPC membership charge. An itemized receipt is especially important when the annual fee combines medical services with nonmedical amenities or when the practice also bills insurance.
Ask the practice to state:
The patient's name
The coverage period
The amount paid
Whether the fee covers one person or more than one person
Which medical services the fee includes
Whether the practice bills members or insurance separately for those services
Whether the practice believes the arrangement meets the requirements of Internal Revenue Code Section 223(c)(1)(E)
The IRS generally requires costs in a mixed arrangement to be separately stated before the medical portion can receive medical-expense treatment.[3] A single receipt that says only “annual membership” may leave your HSA custodian, FSA administrator, or tax preparer without enough information.
Six Reimbursement Mistakes to Avoid
1. Assuming the account debit card proves eligibility
A successful card transaction does not settle the tax treatment. Keep the contract, receipt, and administrator correspondence.
2. Confusing HSA spending with HSA contribution eligibility
A qualifying DPC fee above $150 per month for one person may be payable from HSA funds while still stopping new HSA contributions during enrollment.[1]
3. Claiming the same expense twice
You cannot receive FSA reimbursement and also take a tax-free HSA distribution for the same fee. FSA substantiation requires you to confirm that another health plan has not reimbursed the expense.[2]
4. Treating every concierge fee as a qualifying DPC fee
Separate insurance billing is common in concierge medicine and can keep the contract outside the special DPC rule.[1]
5. Assuming the membership replaces insurance
DPC and concierge memberships cover primary care. They do not replace insurance for hospital stays, surgery, specialists, or expensive medications. Our guide to the main types of primary care explains where membership medicine fits.
6. Counting the membership toward your insurance deductible
The IRS says a DPC fee paid outside the health plan does not count toward the plan's deductible or out-of-pocket maximum.[1]
Questions to Ask Before You Pay
Ask the practice:
Is this contract intended to qualify as a direct primary care service arrangement under Internal Revenue Code Section 223?
Do you bill me, Medicare, or private insurance separately for any care available only to members?
What medical services does the periodic fee cover?
Does the agreement include prescription drugs, advanced laboratory work, procedures requiring general anesthesia, or non-primary-care services?
Can you provide an itemized receipt and a copy of the membership agreement?
Does the fee cover one person or more than one person?
Ask the HSA custodian, FSA administrator, or tax adviser:
Will you reimburse this specific contract?
What documentation do you require?
If the fee exceeds $150 per month for one person, how does that affect my HSA contribution eligibility?
When does the FSA treat the expense as incurred?
Do I need separate receipts for medical services and nonmedical amenities?
Get the answers in writing. Phone guidance can be difficult to prove later.
How to Compare DPC and Concierge Practices
Start with the type of relationship you want, then confirm the tax treatment before treating it as part of the price.
Access Private Medicine in Midlothian is one example of a physician-led DPC practice listed at $125 per month in NextMD directory data. Patients comparing DPC and concierge doctors in Texas can find many different contract structures at similar prices. Each practice still needs to confirm what its membership covers and how it bills.
NextMD lets you search physician-led concierge and DPC practices, compare listed prices, and review doctor credentials. Tax eligibility belongs on the same checklist as access, insurance billing, and services included.
FAQ
Are DPC membership fees HSA eligible in 2026?
Yes, when the contract meets the federal definition of a direct primary care service arrangement. The fixed fee must be the sole compensation for covered primary care, and the arrangement must satisfy the service restrictions in IRS Notice 2026-05.[1]
Can I contribute to an HSA while paying for DPC?
Generally yes if you otherwise qualify and the aggregate DPC fee does not exceed $150 per month for one person or $300 per month for an arrangement covering more than one person in 2026. Higher qualifying DPC fees may still be HSA-reimbursable but can stop new contributions during the enrollment months.[1]
Are concierge doctor fees HSA eligible?
Sometimes, but do not assume the entire retainer qualifies. A typical concierge membership that requires the fee and also bills insurance for member care generally does not meet the special 2026 DPC rule. Ask for the contract and an itemized statement, then confirm the result with your HSA custodian or tax adviser.[1][3]
Are concierge or DPC fees FSA eligible?
They may be, depending on what the fee covers and the employer plan's rules. The special 2026 law addresses HSAs. An FSA administrator can require documentation and can deny an expense that its plan does not cover.[2][4]
Can I pay the annual DPC fee from my HSA at the beginning of the year?
Generally yes for a substantiated qualifying DPC arrangement. IRS guidance permits reimbursement on the first day of each month, the first day of the coverage period, or the date the fee is paid.[1]
Does a DPC membership count toward my insurance deductible?
No. The IRS says fees for DPC membership do not count toward the high-deductible health plan's deductible or out-of-pocket maximum because the health plan does not cover the membership.[1]
Do I still need health insurance with DPC or concierge medicine?
Yes. Membership medicine focuses on primary care. Keep insurance for hospital care, surgery, specialists, emergency treatment, and expensive prescriptions.
NextMD helps you find and compare physician-led concierge and direct primary care practices across the United States. Browse by city, compare listed prices, and view doctor credentials at nextmd.ai/search.
Sources
Internal Revenue Service. (2026). Notice 2026-05: Expanded Availability of Health Savings Accounts Under the One, Big, Beautiful Bill Act. Defines qualifying direct primary care service arrangements, the $150/$300 contribution-eligibility limits, permitted HSA reimbursement, excluded services, billing requirements, and deductible treatment. Read IRS Notice 2026-05
Internal Revenue Service. (2025). Publication 969: Health Savings Accounts and Other Tax-Favored Health Plans. Explains HSA qualified medical expenses, health FSA reimbursement rules, substantiation, and the prohibition on advance reimbursement of projected FSA expenses. Read IRS Publication 969
Internal Revenue Service. (2025). Publication 502: Medical and Dental Expenses. Defines qualifying medical care and explains the treatment of separately stated medical costs within mixed payments. Read IRS Publication 502
Internal Revenue Service Office of Chief Counsel. (2011). Information Letter 2011-0027: Medical Concierge Fee Reimbursement. Explains that a reimbursement arrangement may apply its own plan rules to a medical concierge fee. Read Information Letter 2011-0027