IGNITEHEALTH PARTNERSHIP
Independent practice guides

Patient payment

HSA and FSA rules for direct primary care fees

The federal HSA rules changed for qualifying direct primary care arrangements in 2026. Health FSA reimbursement remains a decision made under the employer plan and its substantiation rules.

DINOMO — Democratized Independent Network of Medical Offices is Ignite Health Partnership’s network for independently owned medical offices. Each office decides whether to use the physician directory, credentialing, payer-contract, revenue-cycle, or MEDFlow services. The office retains its own clinical and business decisions.

Section 01

HSA treatment beginning in 2026

Beginning in 2026, enrollment in a qualifying direct primary care service arrangement does not by itself disqualify an otherwise eligible person from contributing to an HSA. Qualifying fixed DPC fees may be paid or reimbursed tax-free from an HSA.

Required conditions include primary care services from a qualifying practitioner, fixed periodic compensation for the included care, and the statutory service exclusions. The contract terms control; actual use does not change whether the arrangement qualifies.

  • For HSA contribution eligibility, aggregate monthly fees across all DPC arrangements cannot exceed $150 for one individual or $300 when an arrangement covers two or more individuals.
  • A qualifying fixed fee above that limit may still be reimbursable from existing HSA funds. The individual cannot make or receive HSA contributions while enrolled in the arrangement.
  • Employer-paid fees cannot also be reimbursed from the employee’s HSA.
  • DPC fees do not count toward an HDHP deductible or out-of-pocket maximum.

Section 02

2026 general HSA and HDHP figures

These annual figures apply separately from the monthly DPC fee test. Confirm current eligibility and plan terms before contributing or requesting reimbursement.

  • HSA contribution maximum: $4,400 for self-only coverage and $8,750 for family coverage.
  • Minimum HDHP deductible: $1,700 for self-only coverage and $3,400 for family coverage.
  • Maximum HDHP out-of-pocket amount, excluding premiums: $8,500 for self-only coverage and $17,000 for family coverage.
  • The usual age-55 catch-up contribution is $1,000.

Section 03

Health FSA reimbursement

Health FSA reimbursement depends on the employer’s plan terms and the administrator’s classification and substantiation requirements. Confirm coverage before enrolling or paying.

The 2026 health-FSA salary-reduction limit is $3,400. A plan that permits carryover may allow up to $680. Those figures do not establish that a specific DPC fee is reimbursable.

Official sources

Review the current source documents and obtain professional advice for the physician, patient, employer plan, and practice location.