Direct primary care (DPC) used to sit in a gray zone for HSA households: pay a monthly membership for primary care, and you might accidentally lose the ability to contribute to your HSA. The One Big Beautiful Bill Act changed the statute; Notice 2026-5 is the IRS walking through what that means in practice for months beginning after December 31, 2025.
The short version
A qualifying direct primary care service arrangement (DPCSA) is generally not treated as disqualifying “other coverage” for HSA eligibility, as long as the arrangement fits the statutory definition and the fees stay inside the monthly caps:
- $150 per month for an arrangement covering one individual
- $300 per month if the arrangement covers more than one individual
Those caps are aggregate. Stack two memberships and blow past $150/$300, and you’ve left the safe harbor.
HSA dollars can also be used tax-free to pay qualifying DPC fees — a welcome change from the old “no insurance premiums from an HSA” reflex that confused a lot of participants.
Where employers should be careful
Notice 2026-5 also reminds plan sponsors that an HDHP itself shouldn’t be used to fund or provide DPC memberships before the deductible in a way that breaks HDHP rules. In other words: employee-level DPC + HDHP/HSA can work; stuffing DPC into the HDHP design without legal review is how you create a compliance headache.
If employees ask whether “my concierge doctor thing” counts, don’t guess from a brochure. Look at whether it’s primary-care-only, fixed periodic fees, and within the monthly limits.