Tag Archives: DPC news

The American healthcare system was built around a simple assumption: most people get their insurance through their employer.

That assumption no longer reflects how millions of Americans actually work. According to the Bureau of Labor Statistics, there were 11.9 million independent contractors in their primary job alone as of July 2023, accounting for 7.4% of total employment. 

Among skilled knowledge workers, the shift is even more pronounced. Upwork estimates that 28% now operate as freelancers or independent professionals, contributing roughly $1.5 trillion to the economy.

This means freelancing isn’t just a side hustle economy; it’s the new workforce, and healthcare needs to catch up.

The System Was Never Meant for Independent Workers

Employer-sponsored health insurance remains the dominant model in the U.S., covering 154 million working-age Americans. For anyone outside that system, the individual market means higher premiums, complex coverage rules, and limited flexibility.

That burden falls hardest on the self-employed. KFF research estimates that 48% of adults under 65 enrolled in individual market coverage are either self-employed, small business owners, or employed by businesses with fewer than 25 workers. For many of them, the individual market isn’t a fallback. It’s their only option.

For millions of these workers, healthcare access still feels tied to a job they no longer have.

That’s the problem Direct Primary Care (DPC) is uniquely positioned to solve. And it’s been solving it for decades.

Direct Primary Care Has Been Solving This for Decades

Long before gig work became a mainstream conversation, physicians were already building a better model.

Frustrated with the fee-for-service treadmill, a growing number of doctors began opting out of insurance billing entirely in the early 2000s, trading bloated patient panels and administrative overhead for something simpler: a flat monthly fee, a smaller roster of patients, and the time to actually take care of them.

It was a direct response to everything broken about the way primary care was being delivered. And it worked.

What’s changed since then isn’t the model. It’s the size of the population that needs it. With thousands of practices now operating in every state, DPC has spent two decades proving itself while the rest of the healthcare conversation slowly caught up. 

A typical membership covers: 

• Unlimited primary care visits
• Same- or next-day appointments
• Preventive care
• Chronic disease management
• Lab testing, and more

All for a predictable monthly fee with no surprise bills.

For gig workers, that structure matters in ways it doesn’t for a salaried employee with a full benefits package. Freelancers don’t get paid sick days. They can’t afford to wait three weeks for an appointment, sit in a waiting room for two hours, or get blindsided by a bill after a routine visit. 

DPC removes all of that. One monthly fee, direct access to a physician, and the ability to get back to work. That kind of predictability is rare in healthcare, and for independent workers, it’s essential.

The Right Structure for Independent Workers

DPC covers the everyday, but what about the extraordinary? For major medical events like hospitalizations or surgeries, a separate insurance plan fills the gap.

The AAFP recommends pairing a DPC membership with a high-deductible wraparound policy to cover emergencies, and supplemental plans like Atlas Direct are built specifically for that purpose.

The ACA Marketplace—the government-run exchange where individuals can shop for and compare health insurance plans outside of employer coverage—is where most independent workers end up looking for that wraparound plan.

On its own, it’s an imperfect solution: premiums are high, and plans aren’t designed with freelancers in mind. But paired with DPC, a low-cost catastrophic or bronze-tier plan becomes a safety net rather than a freelancer’s entire healthcare strategy. 

The result costs less, delivers more access, and actually fits the way independent workers live.

Policy Is Finally Catching Up

For years, a quirk in IRS rules treated DPC membership as disqualifying coverage, penalizing people for choosing a model that saved them money and improved their care. 

That changed on January 1, 2026. Since then, individuals enrolled in qualifying DPC arrangements can now contribute to and use a Health Savings Account. 

Fees up to $150 per month for individuals ($300 for families) qualify for HSA contributions and tax-free reimbursement, making the DPC-plus-HDHP combination more financially accessible than ever for the self-employed.

The model didn’t need a policy to validate it. But removing that barrier means more people can access it.

Healthcare That Travels With the Worker, Not the Job

Work in America has changed. When nearly four out of ten workers participate in freelance or independent work, tying healthcare to traditional employment is a system built for a workforce that no longer exists.

The BLS data make the stakes clear: 80.3% of independent contractors prefer their work arrangement, yet they remain far less likely to have health insurance than their employed counterparts. 

That gap is real, and it has a cost: deferred care, financial risk, and workers who have to weigh a doctor’s visit against a day’s pay.

Direct Primary Care closes that gap. It gives independent workers consistent access to a primary physician, predictable costs, and a foundation they can build real coverage around. Paired with a lean insurance plan and an HSA, it delivers what the traditional employer-based model was never designed to provide: healthcare that travels with the worker, not the job.

This isn’t a new idea waiting to be proven. Physicians have been practicing it, and patients have been choosing it. The rest of the system is finally starting to agree.

For years, DPC doctors and patients have faced an unnecessary hurdle: federal rules created uncertainty around whether a DPC membership could be combined with a Health Savings Account (HSA), and many people avoided doing so.

That’s changing.

Since the passing of the “One Big Beautiful Bill Act”, DPC will finally be recognized for what it is: a direct medical service. Patients will be able to pair DPC memberships with high-deductible health plans (HDHPs) and use their HSAs to pay for DPC, all without jeopardizing their HSA eligibility.

This guide will give you everything you need to know about HSAs, what’s changing, how these changes affect your patients, employers, and DPC as a whole, and how to communicate these changes effectively.

Let’s break it down.

What Is an HSA?

An HSA is a tax-advantaged account available to patients with an HDHP. Patients contribute pre-tax dollars, let that money grow tax-free, and withdraw funds tax-free for qualified medical expenses.

For 2025, the IRS has set contribution limits at $4,300 for individuals and $8,550 for families, with an additional $1,000 “catch-up” allowance for those age 55 and older. 

Unlike a flexible spending account (FSA), the money in an HSA rolls over year after year; there’s no “use it or lose it.” 

The account is portable, meaning it belongs to the patient rather than their employer, and it also offers retirement flexibility. After age 65, funds can be withdrawn for non-medical expenses and are taxed the same as ordinary retirement income.

Together, these features make an HSA much more than a short-term spending tool. For many patients, it functions as both a healthcare fund and a long-term savings vehicle.

How HSAs Work in Practice

Most patients use their HSA for everyday qualified expenses, such as office visits, prescriptions, lab tests, mental health care, and medical devices. HSAs function almost like a debit card, except with the bonus of tax-free spending.

There’s also a retirement twist: once a patient turns 65, HSA withdrawals for non-medical expenses are simply taxed like regular retirement income. That means an HSA acts like a hybrid: part health fund, part retirement account.

For everyday care, though, the main value is straightforward: patients use pre-tax dollars to pay for the care they need, when they need it.

What’s Changing

For years, many patients wanted to know if they could use their HSA to pay for their DPC membership. They could use HSAs for labs, imaging, or prescriptions ordered through their DPC doctor, but not the membership fee itself.

However, DPC will soon be formally recognized as a qualified medical expense under federal law. In practical terms, this means patients will be able to use HSA funds to pay for their monthly DPC memberships, just as they would for any other direct healthcare service.

On top of that, patients enrolled in DPC who also have a qualified high-deductible health plan will be allowed to contribute to an HSA. This means they’ll be able to enjoy the simplicity of direct care and the tax advantages of an HSA.

The law also sets clear financial and scope limits for qualifying DPC arrangements:

• Patients can use HSA dollars for up to $150 per month for individuals or $300 per month for families, indexed for inflation.
• The membership must provide primary care services by a primary care practitioner, paid via a fixed periodic fee, not per-visit billing.

The legislation also expands access in a few key ways:

• Bronze and Catastrophic marketplace plans will automatically qualify as HSA-eligible HDHPs, giving more patients access to the DPC + HDHP + HSA combination. This change applies to individual marketplace plans, not the Small Business Health Options Program or small-group exchanges.
• The telehealth safe harbor is now permanent, allowing patients to use telehealth services— including DPC virtual visits—before meeting their deductible without affecting HSA eligibility.
• The Dependent Care FSA limit increases from $5,000 to $7,500 per household (or $3,750 if married filing separately) and is not indexed for inflation. This gives employers more flexibility when designing benefits.

The IRS will issue additional guidance in the coming months to clarify documentation standards and reimbursement procedures. We expect to see specifics on:

• How clinics should itemize HSA-eligible charges
• How patients can substantiate claims if audited
• How the monthly caps will adjust for inflation

Basically, the framework is set. Now, we’re waiting for the fine print.

What This Means for Your Clinic

You don’t need to overhaul your practice, but a few smart updates will set you up for success.
The goal is to make your DPC structure crystal clear: you provide medical care, not insurance. That distinction will matter when patients start using their HSAs for membership payments.

Here’s how to prepare:

• Offer clear, itemized invoices. Some patients will need statements to submit for HSA reimbursement; others may pay directly with an HSA debit card. Transparent, consistent invoices make it easy either way.
• Educate your patients early. A brief email or handout explaining what’s changing and when will position your clinic as a trusted guide. Consider including the $150/$300 HSA caps so patients understand the rules upfront.

These are minor adjustments, but they’ll save you time, strengthen compliance, and demonstrate to patients that you’re ready for the next chapter of DPC.

Opportunities with Employers and HDHPs

This change doesn’t just benefit individual patients; it opens a huge opportunity for employer partnerships. For years, many small businesses have sought to combine DPC with HDHPs, but the HSA restrictions have made that combination legally murky. 

Now, that barrier is gone. Employers can confidently build benefit packages that blend:

• DPC for everyday, relationship-based primary care
• An HDHP for catastrophic or hospital coverage
• An HSA for tax-free healthcare spending

And with ACA Bronze and Catastrophic marketplace plans now classified as HSA-eligible HDHPs, more employees than ever can participate in these plans.

Together, these pieces form a comprehensive, affordable system, one that rewards prevention and puts doctors, not administrators, back at the center of care.

For DPC clinics, this opens new opportunities to partner with local employers. You can approach them not just as healthcare providers, but as strategic allies in lowering costs and improving access. Employers save money, employees get better care, and your practice becomes the foundation of a healthier, more sustainable benefits model.

How to Communicate the Change to Patients

Patients may not be familiar with the finer points of HSAs, so it helps to keep the explanation simple. One way is to frame the account as a kind of “tax-free health wallet.” They put money in before taxes, and when they spend it on medical care, they don’t owe taxes on it at all.

Explain how that money can be used to pay directly for their DPC membership. That means patients no longer have to think of DPC as separate from their health benefits; it’s fully part of their HSA strategy.

You might say something to the point like:

“Beginning in 2026, you’ll be able to use your HSA to pay for your DPC membership. You’ll keep your high-deductible plan for major coverage and use your HSA for ongoing primary care, all while saving on taxes.”

To make communication easy, consider a few quick steps:

• Create a short FAQ or handout. Explain what’s changing, when it takes effect, and how patients can use HSA funds to cover their membership up to the federal limits of $150/month for individuals or $300/month for families.
• Add a note to your website or onboarding materials. A short paragraph or banner update can reassure both new and existing members that your clinic is ready for the change.
• Plan an email or text update once IRS guidance is final. A “Here’s what this means for you” message with a link to your FAQ will go a long way.

Your patients don’t need the legal fine print. They just need to know that the care they already love is about to get even easier to manage, and that you’ve got them covered every step of the way.

It can also be useful to paint the bigger picture. An HDHP handles catastrophic events, DPC provides everyday care, and the HSA ties it all together by offering patients a tax-advantaged way to fund both. 

Encouraging patients to contribute regularly—even modest amounts—helps them build a cushion that covers not only routine care but also unexpected needs.

Why This Matters for the DPC Movement

This isn’t just a regulatory update: it’s a validation of everything DPC doctors have been building toward for years.

For years, DPC physicians have built a model centered on time, transparency, and trust, long before policymakers caught up. 

With this legislative change, that commitment is being reflected at the national level. The law now makes clear that what happens inside your practice is medical care, not insurance.

Allowing HSA funds to be used for DPC memberships means patients can now invest pre-tax dollars in preventive, relationship-based care, the kind that keeps them healthier, longer.

And for the DPC community, it’s a turning point. It demonstrates that a grassroots, patient-first approach can influence federal policy, showing that when care is personal, it can scale.

This recognition doesn’t redefine DPC; it reinforces it. The system is simply catching up to what DPC doctors have been doing all along: delivering meaningful, measurable care without middlemen.