Maryland

Any bulletin or ruling on memberships where no statute exists

Yes. A retainer fee that covers unlimited office visits is, in the regulator's view, the business of insurance.

The Maryland Insurance Administration's January 2009 report separates two models. A practice that sells a comprehensive annual physical for a market price does "not appear to be engaged in the business of insurance." A practice that bundles an annual physical with unlimited office visits for one fee is different: "This type of arrangement, in the MIA's view, would constitute the business of insurance." The report names five warning signs: a fee covering unlimited visits or more services than the physician can reasonably provide to every patient in the panel; no limit on the number of patients accepted; a fee that does not represent the fair market value of the promised services; substantial financial risk for services rendered by other providers; and an agreement that cannot be ended during the year or gives no pro-rated refund. The report dates from 2009, and we have not checked whether a later bulletin updates it.

Checked September 17, 2026

Whether the state follows the federal HSA rules for DPC

No add-back. Contributions excluded from federal adjusted gross income stay excluded on the Maryland return.

The Comptroller's income tax questions and answers say: "You do not have to add back the contributions that you make to your employer-maintained health savings account or any other qualified 'cafeteria plan'" that meets section 125 of the Internal Revenue Code. The Maryland return starts from federal adjusted gross income, so the federal treatment carries through. It is not a separate Maryland deduction, and that answer addresses employer-maintained accounts, so confirm your own situation with a tax professional.

Checked September 17, 2026