Self-Employed & DPC · Straight answer

Can you use an HSA with direct primary care?

Yes, as of January 1, 2026. Under the 2025 federal tax law, a direct primary care membership costing up to $150 per month for an individual ($300 for a family) no longer blocks you from contributing to an HSA, and fees within those limits are qualified medical expenses you can pay from the HSA. Before 2026, the IRS treated DPC as disqualifying coverage, so this is a genuine reversal.

Last reviewed August 17, 2026 · Published August 17, 2026 · Mere Benefits Data Desk

The new rule has boundaries worth knowing before you rely on it. The fee caps are per month, the arrangement must consist of primary care services from primary care practitioners, and you still need an HSA-eligible high-deductible health plan to contribute at all. A DPC membership alone never makes you HSA-eligible; it just stops disqualifying you. Practices whose agreements bundle in services outside primary care, such as procedures requiring general anesthesia or most prescription drugs beyond vaccines, may fall outside the definition, so ask the practice how its agreement is structured.

Before and after the 2026 change

Question	Through 2025	From January 1, 2026
Does a DPC membership disqualify HSA contributions?	Yes, IRS treated DPC as a disqualifying health arrangement	No, if the fee is at or under $150/month individual, $300/month family (indexed for inflation after 2026)
Can HSA dollars pay the DPC fee?	No, not a qualified medical expense	Yes, within the same fee limits
Do you still need an HDHP to contribute?	Yes	Yes, for 2026: deductible at least $1,700 self-only / $3,400 family

The change comes from the 2025 federal tax law, Public Law 119-21, signed July 4, 2025, effective for months beginning after December 31, 2025.

What the combination looks like in practice

Worked example for 2026: a 40-year-old self-employed contractor pairs a self-only HSA-eligible bronze marketplace plan with a $95-per-month DPC membership. Because $95 is under the $150 limit, he may contribute the full 2026 HSA maximum of $4,400, and he can pay the $1,140 of annual DPC fees straight from the HSA with pre-tax dollars. His primary care is handled for a flat fee, his insurance covers the catastrophic tail, and the tax code now cooperates with all of it.

If his practice instead charged $175 per month, he would be over the individual limit. Exceeding the cap does not just make the excess non-reimbursable; it can make the membership disqualifying again, putting his HSA contributions for those months at risk. The dollar limits are indexed for inflation in years after 2026, so check the current figure each January.

Practical steps if you want to do this

Confirm the health plan itself is HSA-eligible. For 2026, the 2025 tax law also treats bronze and catastrophic marketplace plans as HSA-qualified, which widens the menu.
Get the DPC fee and scope of services in writing and keep the agreement with your tax records.
Keep monthly receipts if you reimburse yourself from the HSA, the same as any qualified expense.
If you are approaching 65, remember the separate Medicare rule: HSA contributions must stop when Medicare starts, and late Part A enrollment can backdate 6 months.

Here’s the mistake I see people make already in 2026: assuming every membership-medicine arrangement qualifies. Concierge practices that bill insurance, and memberships bundling non-primary-care services, may not fit the definition. When the fee is near the cap or the agreement is unusual, have a tax professional look before you contribute.