The recently passed One Big Beautiful Bill (OBBB) includes long-awaited provisions affecting direct primary care (DPC). Below, we answer the most common questions pediatric DPC physicians may have about what the law actually says, when it takes effect, and how it impacts our practices and patients.
Q: What does OBBB actually do for direct primary care?
OBBB creates a legal definition of a “Direct Primary Care Service Arrangement” (DPCSA) and sets rules for when these arrangements can be paired with Health Savings Accounts (HSAs). Specifically, it makes clear that qualifying DPC memberships do not disqualify individuals from contributing to HSAs and are considered HSA-eligible medical expenses (so patients can pay membership fees directly from HSAs).
Q: How does the law define a DPCSA?
A DPCSA is an arrangement where an individual pays a fixed periodic fee (not per-service billing). Services must be primary care only, provided by physicians in pediatrics, family medicine, internal medicine, geriatrics — or NPs, PAs, and CNSs. Excluded from “primary care services” are procedures requiring general anesthesia, prescription drugs (except vaccines), and labs that aren’t normally performed in an ambulatory primary care setting.
Q: What are the membership fee limits under OBBB?
To qualify as HSA-eligible, monthly membership fees cannot exceed $150 per month for an individual, or $300 per month for more than one individual (e.g. family). These amounts will be indexed for inflation going forward.
Q: When do these changes take effect?
For most taxpayers and plan years, the new rules apply starting January 1, 2026.
Q: If my practice charges above those amounts, can patients still pay part from an HSA and the rest out of pocket?
Unfortunately, no. The caps are all-or-nothing. If your membership fee is above the $150 / $300 thresholds, the entire arrangement falls outside the DPCSA safe harbor. That means the membership fee would not be considered an HSA-eligible medical expense, patients would have to pay entirely out-of-pocket, and there is also potential risk that an “over-cap” DPC arrangement could be viewed as disqualifying coverage for HSA purposes. We are still waiting on IRS/Treasury guidance for possible flexibility (such as tiered or split arrangements), but as written, the statute is strict.
Q: Does this mean I need to lower my prices?
Not necessarily. OBBB doesn’t restrict what you can charge; it only defines what qualifies for HSA treatment. Many practices may decide to offer a “base” compliant tier that falls under the safe harbor, and then additional non-HSA-eligible add-ons for families who want expanded services.
Q: What does this mean for my patients?
For families with High Deductible Health Plans (HDHPs) and HSAs, this is a game-changer. They can now combine tax-advantaged savings with predictable, relationship-based care. Paying DPC fees with pre-tax dollars reduces the net cost, and employers may be more willing to include DPC in their benefits strategy.
Q: What are the limitations to keep in mind?
Scope of services: services outside “primary care” may jeopardize eligibility. Fee caps: if you want your patients to use HSAs, you must stay under the thresholds. Unclear boundaries: some gray areas remain in defining “primary care services” — future IRS/HHS guidance will be critical.
Q: What if pediatricians disagree with the fee caps?
Many pediatricians feel the $150 / $300 caps don’t reflect the higher-intensity, time-consuming care that children — especially those with developmental, behavioral, or complex needs — often require. If you disagree with the caps, there are ways to advocate for change. You can engage through DPC advocacy groups, which can lobby for pediatric-specific adjustments. You can submit comments when the Treasury and IRS open formal rulemaking, highlighting how low caps risk excluding vulnerable children from access to DPC. You can also share data and stories with legislators about how pediatric DPC saves costs downstream by reducing ER visits and specialty referrals. Another strategy is proposing refinements, such as higher caps for pediatrics, regional cost adjustments, or allowing tiered models. In short, while the law sets today’s limits, there is a path forward for physicians to shape future policy.
Q: Bottom line?
The OBBB provides long-awaited clarity: qualifying DPC memberships can be paid with HSA dollars starting in 2026. But the benefit only applies if your arrangement fits within the law’s definition and fee caps. For pediatric DPC practices, this opens up new ways to serve families — but also requires careful structuring of membership tiers and communication with patients about what is and isn’t HSA-eligible.
In future newsletters, we’ll update you as the IRS releases implementing guidance. For now, this is a major win for the DPC movement — and especially for families who want pediatric care that’s affordable, accessible, and personal.
