Congress recently made it easier for Americans to pay their doctors directly. But federal rules still prevent their health insurance from counting those payments toward a patient’s deductible or out-of-pocket maximum.
Direct Primary Care (DPC) offers a simple alternative to conventional primary-care: patients pay a fixed monthly fee directly to their physician in exchange for routine primary-care services, often without insurance claims or billing departments. For patients with high-deductible health plans (HDHP), the arrangement could be particularly useful, pairing routine primary care with insurance for larger, less predictable medical expenses.
Until this year, federal Health Savings Account (HSA) rules stood in the way of such a pairing. To contribute to an HSA, patients generally must be enrolled in a qualifying high-deductible health plan and cannot have another health plan that provides medical benefits before the deductible is met. Because DPC arrangements provide primary-care services in exchange for a monthly fee, they could be treated as disqualifying additional health coverage, potentially making participants ineligible to contribute to an HSA. Congress fixed that problem. Effective in 2026, qualifying DPC arrangements are not treated as disqualifying health plans for HSA purposes, and patients may use HSA funds to pay qualifying DPC fees.
Justin Leventhal is a Senior Policy Analyst for the American Consumer Institute, a nonprofit education and research organization that advocates for consumers through evidence-based analysis and data. Follow Justin on X @JustinLeventhal