You Can Now Use HSA Dollars for Direct Primary Care

Every so often, a rule changes in healthcare and everyday life actually gets a little easier. This is one of those times. As of January 1, 2026, families with a health savings account (HSA) can use those pretax dollars to pay for a direct primary care membership. For folks here in Montana who already love the simplicity of membership-based care, or who have been curious about it, this is worth understanding.

What changed, in plain English

A health savings account lets you set aside money before taxes to spend on qualified medical expenses. It has long been one of the most practical tools a family or small business owner has for managing healthcare costs. The catch was that, under the old IRS reading, joining a direct primary care practice could count as having "other coverage." That technicality could knock you out of HSA eligibility entirely, even though a membership is not insurance and was never meant to replace it.

Congress fixed that mismatch in the federal budget law passed in the summer of 2025. According to a report from Texas Medicine, the publication of the Texas Medical Association, the change takes effect January 1, 2026, and it does two big things. First, a direct primary care membership no longer disqualifies you from contributing to an HSA. Second, membership fees themselves can now be treated as a qualified medical expense, which means you can pay them with HSA dollars.

The fine print that matters

Like anything involving the tax code, there are guardrails. The Texas Medicine report lays out the main requirements a membership arrangement has to meet:

• The practice provides primary care services, delivered by primary care practitioners.
• The arrangement does not include procedures requiring general anesthesia, prescription drugs other than vaccines, or lab work beyond what is typical in an everyday primary care setting.
• You pay a flat, recurring fee with no per-visit charges.
• To keep your HSA eligibility, the total cost of your memberships stays within limits set by the law: $150 per month for an individual or $300 per month for a family, with adjustments for inflation over time.

Most straightforward direct primary care memberships fit comfortably inside those lines. If you have questions about your own situation, your tax professional is the right person to walk you through it.

Why this is a big deal for regular families

Direct primary care is built on a simple idea: you pay your doctor's office a predictable monthly fee, and in return you get real access to primary care. No surprise bills for a visit. No wondering whether a quick question will turn into a statement in the mail. The doctor works for you, not for a claims process.

The numbers help explain why so many families find this appealing. The Texas Medicine report cites KFF research showing the average annual deductible for employer-sponsored insurance reached $1,735 back in 2023. Compare that with data from the American Academy of Family Physicians showing typical direct primary care fees of roughly $20 to $49 per month for kids and $50 to $100 per month for most adults. For a lot of households, the membership costs less than the deductible they were never going to hit anyway.

Physicians quoted in the report also point to something harder to measure: time. With less paperwork between doctor and patient, visits can be longer and more personal. That is the kind of care most of us remember from small-town Montana, and it is the kind of care we believe in.

What it means for small businesses

If you run a shop, a ranch, a restaurant, or a small crew here in Montana, you know the yearly dread of renewal season. The new rules give employers another practical lever. Employees with HSA-compatible high-deductible plans can now layer a direct primary care membership on top without breaking their HSA, and they can pay for it with pretax dollars. The same law also made some bronze and catastrophic plans HSA-eligible starting in 2026, and made permanent the rule letting high-deductible plans cover telemedicine before the deductible is met.

None of this replaces insurance, and that point matters. A direct primary care membership is not insurance and does not cover hospital stays, surgeries, or emergencies. Most members pair their membership with insurance or another form of coverage for the big stuff. What the membership does is take excellent care of the everyday layer: checkups, sick visits, chronic condition management, and a doctor who knows your name.

The bottom line

Washington does not often hand out changes that make healthcare simpler. This one does. If you have an HSA, your dollars now stretch further and can pay for the kind of relationship-based primary care that membership models are built around. If you have been on the fence about direct primary care, 2026 removed one of the last practical hurdles.

This article is general information, not medical or financial advice. Please talk with your own doctor, tax advisor, or benefits professional about your specific situation.

Curious what membership-based care could look like for your family or your team? Visit coremedhealth.com or drop us a line at info@coremedhealth.com. We are always happy to talk it through, neighbor to neighbor.