By: HUB’s EB Compliance Team

The One Big Beautiful Bill Act (“OBBBA”) has created significant opportunities for Direct Primary Care (“DPC”) arrangements. With a broad choice of vendors offering a variety of solutions, it can be challenging to determine if an arrangement meets the OBBBA requirements for DPCs. This article will discuss the DPC requirements and describe arrangements which may look similar on their face, but are not considered DPC under the Act.

Direct Primary Care

Under OBBBA, “A Direct Primary Care Service Arrangement is an arrangement under which an individual is provided medical care consisting solely of primary care services provided by primary care practitioners, and the sole compensation for such care is a fixed periodic fee.” Primary care services shall not include:

  • 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.

Under a DPC arrangement, the only fee is the applicable periodic (be it an annual, quarterly, or monthly) fee. There can be no additional charges for seeing providers.

To be HSA compatible, the DPC must also comply with cost limitations on the aggregate fees for all DPCs a person may have (meaning that individuals may have access to multiple DPC arrangements). The limitation for 2026 for an individual is $150, and for more than one individual the 2026 limit is $300. Both amounts will be adjusted annually for inflation. Importantly, these limits apply to the total cost of all DPCs an individual may have. Thus, if in 2026, an individual has DPC A at a cost of $100 per month and DPC B at a cost of $75 per month, this individual would not be HSA eligible since the aggregate cost of all DPCs exceeds the prescribed limit.

To summarize, to be an HSA compatible DPC, all of the following requirements must be met:

  1. The arrangement provides services consisting solely of primary care services provided by primary care practitioners.
  2. The arrangement cannot provide any of the excluded services.
  3. The sole compensation is a fixed periodic fee.
  4. The aggregate cost of the arrangements cannot exceed the allowable amounts.

Other Programs

Concierge medicine is growing among certain employers and does not have a statutory definition. The absence of a statutory or formal definition means programs that work in different ways can describe their programs as “concierge”. Thus, using this term to describe a particular program does not provide any indication of what the program does, or how it works.

One way a concierge medicine program can work is by charging a fee for access to certain providers. The providers may or may not accept insurance, and if they do, they may be in or out of network for a particular plan. If the providers accept insurance, they may bill the individual’s plan just like any other provider. Note, there are a myriad of different ways these programs may work, so those engaging such a program should work with the program to understand its specifics.

Concierge programs may also provide other perks to members. These perks will vary by program and may include telemedicine, enhanced technology, guaranteed access to providers, etc. Some programs may even include house calls, off-hours appointments, or other enhanced access to care. Although concierge medicine programs may resemble DPC in structure and patient experience, they often include features that place them outside the OBBBA’s definition of DPC.

Examples

Below are two examples that illustrate the differences between a DPC and a non-DPC concierge program.

  • Dana is a physician at ABC Direct Primary Care. ABC’s services are limited to the allowable services, and they charge their patients a monthly membership fee of $100 for individuals or $200 per family.
    • Stanley Roper is a patient of ABC. He has three office visits with Dr. Dana in July. He only pays his $100 monthly membership fee.
      • This is an HSA compatible DPC arrangement because the services are compliant, the only compensation ABC receives is the fixed periodic fee, and cost is within the allowable limits.
    • PA Paul is a physician assistant at All Star Concierge Medicine. All Star charges individuals $300 or families $500 per year for the right to access their providers.
      • Helen Roper is a patient of All Star. She has three office visits with PA Paul in July. She pays her $300 annual membership fee andincurs claims under her plan for each office visit.
        • This is a concierge arrangement and not an HSA compatible DPC arrangement since, at a minimum, All Star receives compensation other than just the fixed periodic fee. Note, this arrangement may be HSA compatible, but it is not a DPC arrangement.

Reminders for Employers

DPC now being HSA compatible (when the applicable requirements are met) also provides an opportunity to remind employers of their obligations related to employees’ HSA contributions. Under guidance provided by the Internal Revenue Service (“IRS”) in Notice 2004-50 Q/A 81 “Employers are only responsible for determining the following with respect to an employee's eligibility and maximum annual contribution limit on HSA contributions:

  1. whether the employee is covered under an HDHP (and the deductible) or low deductible health plan or plans (including health FSAs and HRAs) sponsored by that employer; and
  2. the employee's age (for catch-up contributions).”

This is especially relevant for DPCs since they are sometimes engaged at the employer level (where an employer provides access to the DPC as part of their medical benefits program), and other times they are engaged at the individual level (where an individual engages a DPC directly, without involvement of the employer). For purposes of HSA eligibility, employers are only responsible for the plans they sponsor. Thus, if an employer offers a DPC to participants in their HDHP, the employer is responsible for ensuring that the DPC is HSA compatible. On the other hand, employers are not responsible for determining whether a DPC engaged at the individual level is HSA compatible.

Conclusion

Employers need to understand the benefits they offer to employees and how those benefits work. This is especially important when employers offer additional medical benefits to employees enrolled in HDHPs.

If you have any questions, please contact your HUB Advisor. View more compliance articles in our Compliance Directory.

NOTICE OF DISCLAIMER
Neither Hub International Limited nor any of its affiliated companies is a law or accounting firm, and therefore they cannot provide legal or tax advice. The information herein is provided for general information only and is not intended to constitute legal or tax advice as to an organization’s or individual's specific circumstances. It is based on Hub International's understanding of the law as it exists on the date of this publication. Subsequent developments may result in this information becoming outdated or incorrect and Hub International does not have an obligation to update this information. You should consult an attorney, accountant, or other legal or tax professional regarding the application of the general information provided here to your organization’s specific situation in light of your or your organization’s particular needs.