Mega Doctor News
Texas Medical Association (TMA)
Patients who see physicians in direct primary care medical practices can now use their health savings account funds to pay their associated membership fees, because of new federal regulations that took effect in early 2026. One physician using the model says this could lead to increased access to care for patients and less red tape for physicians.
The change took effect Jan. 1 under Congress’ budget bill, known as the One Big Beautiful Bill Act, which included a $40 billion expansion to tax-preferred health savings accounts. Patients previously could not use those accounts’ funds to pay for direct primary care services such as their membership fees.
“This is going to give patients and doctors [who provide primary care services as defined by the federal law] a lot more control and flexibility, without insurance interference,” said Amy Townsend, MD, chair of the Texas Medical Association (TMA) Committee on Independent Physician Practice.
The Bridge City family physician transitioned her practice to direct primary care five years ago – a switch she says allowed her to claim full authority over the care she provides and payment she accepts. Until now however, that excluded payment from patients’ health savings accounts.
Patients enrolled in a high-deductible health plan can establish a health savings account. They then can withdraw that accounts’ funds tax-free to pay for qualifying health care expenses, including deductibles, copayments, and prescriptions. Federal tax law previously prohibited patients from paying direct primary care membership fees with their health savings account funds.
Direct primary care medical practices allow patients to pay a recurring membership fee directly to a primary care physician for medical services, bypassing the need for traditional insurance billing. Patients have access to the physician for certain care as a result.
For example, Dr. Townsend’s practice allows her patients to purchase a membership that grants unlimited access to certain primary care services – like routine screenings and acute-care visits – directly from her practice without having to file an insurance claim. Patients pay a monthly fee to access those services as needed, without having to make an additional payment at the time of the health care visit.
Physicians and patients with experience using this model typically report they have more time together during a health care visit, feeling less rushed. The physicians also report enjoying more clinical autonomy. For example, they do not have to wait for prior authorization from a patient’s insurance company to grant permission to provide care or a prescription for that patient.
“When I started my own [direct primary care] practice, I could finally become the type of physician that I’ve always wanted to be,” Dr. Townsend told TMA’s Texas Medicine magazine in 2025.
Previously, participating in a direct primary care arrangement would disqualify patients from having a high-deductible health plan, which is necessary to qualify for a health savings account – in addition to federal tax law prohibiting patients from paying direct primary care membership fees from their health savings accounts. Now they can use health savings account dollars to pay direct primary care membership fees – if:
The arrangement provides services consisting solely of primary care services provided by primary care practitioners;
The arrangement does not provide 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;
The sole compensation is a fixed periodic fee, without per-visit charges; and
The aggregate cost of arrangements does not exceed the allowable amounts established by the law, which are $150 per month for individuals or $300 per month for family arrangements, with annual adjustments for inflation. These l
Information source: TMA
