How above-the-cap membership practices can still capture the 42 million funded HSA accounts.

By Danny Friday & Dennis M. Sponer, Guest Article Contributors

Americans hold $174 billion across nearly 42 million HSAs, and new rules finally let those dollars pay for direct primary care. Concierge medicine practices should take advantage of this unprecedented growth opportunity—even if their membership fees are too high to qualify.

The membership medicine industry finally got the policy win it has requested for two decades: as of January 1, 2026, HSAs can be used to pay for qualifying direct primary care membership fees with tax-free dollars, and patients can keep their HSA contribution eligibility while enrolled.

It is a genuine victory, but the statute limits fees to $150 a month for individuals, or $300 a month for families. While that might seem like a limitation at first, it presents an unprecedented opportunity. Whether a practice takes that opportunity will matter more to its growth over the next five years than almost any marketing decision.

The mechanics

First, we need to understand what’s required for DPC membership fees to be payable with an HSA.

There are three requirements:

• The arrangement’s sole compensation must be a fixed periodic fee. Any per-visit primary care billing disqualifies the arrangement.
• The arrangement must cover only primary care services. Specialist coordination, advanced imaging, executive physicals, prescription drugs, or non-routine lab work disqualify the arrangement.
• The monthly fee cannot exceed $150 for an individual or $300 for a family. If the member pays for a fee above the cap, the member loses the ability to contribute to an HSA while enrolled.

What the law did not do

The law provided no relief for traditional concierge medicine with annual fees above the cap (think $5,000 to $25,000 a year). From an HSA perspective, those fees are not considered DPC arrangements, and Congress’s silence was not an oversight. It chose to support the affordable wing of membership medicine while declining the luxury wing.

Some practices will create a new offering to meet the DPC definition by creating a plan with an HSA-payable fee that sits under the cap. Some of that will be straightforward, but some of that will test the boundaries of what “primary care services” means—and the practices that get it wrong will create tax problems for their members.

The opportunity above the cap

Here’s the counterintuitive thing: you don’t need to create a plan with a DPC-qualifying fee to benefit from this historic change. You just need to let the emerging and existing HSA population know you’re there for them.

For example, let’s say your practice prices its plans at more than $150 a month. While your membership fees won’t qualify, much of what your practice delivers already does, and the HSA audience just needs to know which expenses qualify. Office visits, labs, imaging, diagnostics, and procedures are all qualified medical expenses on their face.

The member paying $5,000 a year is very often sitting on a funded HSA or FSA that could absorb thousands of dollars of that underlying care. Practices can serve this population by sending an HSA-tailored invoice after each visit that separates qualified care from the membership fee and by resending a personalized HSA reminder a few times a year. Practices can deliver real savings to members without discounting a dollar of practice revenue. Most importantly, it can help those members feel covered when the fee is not.

These members are pre-funded

Today’s macroeconomic context makes the effort worth it. Americans hold 41.7 million HSAs containing nearly $174 billion, with invested balances up 33% year over year. Financial advisers treat HSA maximization as standard planning for the type of household that buys membership care.

And the growth is impossible to ignore: 9 million people selecting 2026 marketplace coverage chose bronze plans that are now HSA-compatible. Self-employed, price-conscious, and poorly served by conventional primary care—that is the ideal demographic for concierge care.

The Approach

Here are three things a practice can do now to capitalize on this opportunity.

• Pull in people by creating a plan with an “HSA-payable” fee. This is the best way to attract an audience that might come for one offering but consider all of them.
• Market how you maximize HSAs for all of your plans, not just the HSA plan. Tell patients you maximize their HSA benefits regardless of the plan they choose. It serves members and addresses price objections.
• Automate the back office. To do all this, substantiation must be collected, statements must go out on a rhythm, and reimbursed dollars must reach the member, which software such as Sail now handles end-to-end.

Providing documentation isn’t just compliance; it is a reason to be in members’ inboxes several times a year to deliver something they actually want to receive. Your members need to know what their HSA covers.

The HSA population is pre-funded, plans ahead, and looks for a practice that makes its dollars easy to spend. Pull them in with an HSA-payable plan if you can, and help them maximize their HSA either way. Practices that do will grow faster than those that don’t.

Dennis M. Sponer, J.D., LL.M., MBA, is the founder of SRX Advisors, a regulatory intelligence and consulting firm that assists PBMs and payers in managing pharmacy costs. He founded and served as CEO of two PBMs, including ScripNet, which managed workers’ comp pharmacy costs in all 50 states. Dennis serves as Of Counsel to Goldsand Friedberg, a health care regulatory law firm.

Danny Friday is CEO of Sail, a fintech company building the future of healthcare payments. He is a software engineer who previously founded a direct-to-consumer telehealth company and served on the COVID-19 Tech Task Force.