A health savings account or flexible spending account can feel like the natural place to pay a concierge membership from. It is money set aside for health care, after all. The rules are narrower than that, and a recent change for direct primary care has added to the confusion. This article explains what changed in 2026, why concierge fees are a different case, and who to ask before you spend.

This is general information, not tax advice. Your own situation depends on your plan and your tax picture.

What changed for HSAs in 2026

A federal law passed in 2025 created a specific rule for direct primary care. The IRS explained it in Notice 2026-5 and summarized it in a news release.

Starting January 1, 2026, a person enrolled in a qualifying direct primary care service arrangement can remain eligible to contribute to an HSA. They can also pay the arrangement’s fees from the HSA, provided the fees are no more than $150 a month, or $300 a month if the arrangement covers more than one person.

Why that rule is about direct primary care

The 2026 rule applies to direct primary care, often called DPC. In a typical DPC arrangement, a monthly fee covers primary care services and the practice does not bill insurance for them. The IRS guidance sets out which arrangements qualify.

Concierge medicine usually works differently. A concierge practice generally bills insurance for visits and tests and charges a separate concierge fee, often once a year. A concierge practice that bills insurance for care, or charges more than the monthly limits, likely does not meet the definition. The IRS has not issued a ruling on concierge fees in general. We explain the broader differences in concierge medicine and direct primary care are not the same.

Why HSA eligibility matters

An HSA comes with rules about who may contribute. The IRS describes those rules in Publication 969, which covers health savings accounts, health flexible spending arrangements and related accounts. Before the 2026 change, many people worried that joining any membership practice could affect their ability to contribute. The new law answered that question for qualifying DPC. It did not answer it for every kind of membership.

If you contribute to an HSA, that is the main reason to get professional advice before you sign a concierge agreement and before you pay the fee from the account.

What about an FSA

A health FSA is offered through an employer, and what it will reimburse depends on the IRS rules for medical expenses and on your employer’s plan. The IRS explains what generally counts as a medical expense in Publication 502. Some plan administrators will ask for a breakdown of what a concierge fee pays for before they decide whether to reimburse it.

Separately, the visits, labs and tests a concierge practice bills to insurance still produce ordinary copays and deductibles. Those are medical costs in the usual sense, and your plan administrator can tell you how it treats them.

Timing can matter too. If you are thinking about joining partway through the year, ask how the fee is billed, whether it is paid up front or in installments, and how that lines up with your account’s plan year.

A short checklist before you pay

  1. Ask the practice for its membership agreement and a written description of what the fee covers.
  2. Ask whether the practice bills insurance for visits and tests.
  3. Ask your HSA or FSA administrator how it treats concierge fees.
  4. Ask a tax advisor whether paying the fee from an HSA, or joining at all, could affect your eligibility to contribute.
  5. Keep copies of the agreement and receipts with your tax records.

How it works at Legacy Medical

Legacy Medical is a concierge practice, not a direct primary care practice. We bill insurance, including Medicare, for visits, labs and tests, and members pay an annual concierge fee that is not billed to insurance. Because of that structure, we do not describe our fee as HSA-eligible, and we encourage anyone who uses an HSA or FSA to check with a tax advisor first.

Our insurance and fees page explains how billing works, and our membership page outlines what members receive. For a wider look at costs, see how much concierge medicine costs.

If you would like to go over the agreement in person before you decide, Dr. Shtern offers a complimentary meet and greet at our Palm Beach Gardens office. You can take the paperwork home to show your advisor.

This article is general information, not advice for your situation. Members can call the office with questions about their own care.