Federal Changes Allow Payment for Direct Primary Care Via Health Savings Accounts
By Alisa Pierce

Patients will soon be able to pay for direct primary care (DPC) arrangements with their health savings accounts (HSAs) – a change that some physicians say may lead to increased access to care for patients and less red tape for clinicians.  

The change takes effect Jan. 1, 2026, under Congress’ budget bill, known as the One Big Beautiful Bill Act (OBBBA), which included a $40 billion expansion to tax-preferred HSAs. 

“This is going to give patients and doctors [who provide primary care services as defined by OBBBA] a lot more control and flexibility, without insurance interference,” said Amy Townsend, MD, chair of the Texas Medical Association’s Committee on Independent Physician Practice (IPP).  

The Bridge City family physician transitioned from hospital-based care to direct primary care in 2020 after experiencing financial strain, a heavy administrative workload, and a lack of clinical autonomy. 

“The environment I used to practice in did not allow me to provide care the way I wanted to. I had minimal freedom to make what I considered the best decisions for my patients, free from outside constraints,” she told Texas Medicine last year. “When I started my own practice, I could finally become the type of physician that I’ve always wanted to be.”  

DPC allows patients to pay a recurring membership fee directly to a primary care physician for medical services, bypassing the need for traditional insurance billing.  In 2023, the annual deductible for employer-sponsored insurance plans, the most common form of coverage, cost patients $1,735 on average, according to an October 2023 study by KFF, not to mention cost-sharing requirements regardless of whether they have met their deductible. 

In comparison, according to a 2024 data brief from the American Academy of Family Physicians, monthly DPC membership fees range from $20 to $49 for children and $50 to $100 for adults ages 65 and under. Monthly membership fees for families were reported at $100 or higher. Over half of DPC arrangements, 62%, charge an enrollment fee and 7% charge per visit fee, according to the report. 

Previously, participating in a DPC arrangement would disqualify patients from having a high-deductible health plan (HDHP), which is necessary to qualify for an HSA. The new law changes this and permits patients to use HSA funds for DPC membership fees, provided the arrangement meets certain federal requirements, such as: 

• The arrangement must provide services consisting solely of primary care services provided by primary care practitioners; 

• The arrangement cannot provide procedures that require the use of general anesthesia, prescription drugs other than vaccines, and laboratory services not typically administered in an ambulatory primary care setting; 

• The sole compensation is a fixed periodic fee, without per-visit charges; and 

• The aggregate cost of arrangements cannot exceed the allowable amounts established by the law which are $150 per month for individuals or $300 per month for family arrangements, with annual adjustments for inflation. These limits apply to the total cost of all DPCs a patient may have.  

Dr. Townsend says DPC models are one method to curb burdensome health care costs while allowing physicians to provide the care they deem necessary. 

As 94% of physicians say prior authorization has a somewhat or significant negative impact on patient clinical outcomes, according to the American Medical Association’s annual prior authorization survey, a study in WMJ, the journal of the Wisconsin Medical Association, found DPC arrangements generally lower physicians’ administrative hassles, freeing them for more time with patients. 

Dr. Townsend says the IPP committee will evaluate potential unintended consequences of the new provisions, such as patients struggling to navigate which services are HSA-eligible and which are not. 

“Hopefully over time, as the DPC model grows, it will lead to the ability for specialists to offer similar structures,” Dr. Townsend said. “But when you create a situation like this where patients can contribute to an HSA and then use those pretax expenses for primary care, it tends to make care less expensive, which is the big thing.” 

Other changes to HSAs under OBBBA include: 

• Bronze and catastrophic tier health plans will be HSA-eligible HDHPs starting Jan. 1, 2026. Patients on these plans, which have higher out-of-pocket costs and high deductibles respectively, will be allowed to use HSAs to save tax-free. The provision applies only to individual health care coverage and doesn’t extend to Small Business Health Options Program or small- and medium-sized business exchange purchases.  

• Certain COVID-era telemedicine provisions that allowed HDHPs to cover telemedicine services without requiring patients to first meet their deductible are now permanent under OBBBA. Starting Jan. 1, 2026, HDHPs will cover telemedicine and remote care services without regard to deductibles and without jeopardizing the patient’s HSA eligibility. 

TMA continues to monitor the broad scope of OBBBA’s potential impact on patients and physicians. Continue to read Texas Medicine Today for coverage of how these and other federal policies might impact health care in Texas and learn more about TMA’s federal advocacy efforts.