This is a common question in the Direct Primary Care world. Now that DPCs, like Direct Doctors, are popping up all over the place, patients want to know what options there are to pay the monthly fee (which is billed to patients directly rather than through insurance as in a typical practice).
Let’s start with the FSA - or flexible spending account. These accounts allow employees to put aside a certain amount of pre-tax dollars to be used on healthcare costs. FSAs are administered and run by various third parties. In our experience, whoever the third party administrator is will determine whether the FSA can be used to cover monthly fees. They allow doctor payments to be covered almost universally, but whether they allow you to set up a monthly direct debit varies from one to the other. For those who prefer not to do monthly fee coverage, they will often allow you to submit a few times a year to request a lump sum reimbursement for the fee you’ve paid up until that point as “doctors fees.”
Bottom line - check with your FSA’s third party administrator on what they prefer!
Now onto the HSA - or health savings account. The IRS has deemed it a non-covered expense to use your HSA for DPC monthly fees. However, there was an executive order signed in 2019 asking the treasury department to look into allowing the use of HSAs specifically for DPC fees. Some interpret this as an authorization for use of HSAs for DPCs. Others interpret this as a continued outstanding issue. The IRS has not changed it’s language yet.
Bottom line - the jury is still out but the IRS says no HSAs for DPC fees.
Most patients use their checking or credit card account to set up a monthly debit directly with Direct Doctors so that their fee is covered. This gives patients access to primary, preventative, and sick care whenever needed. The value of this service for most patients outweighs the potential roadblocks to coverage under an HSA (and sometimes FSA). In addition, our practice works especially well when folks have high deductible healthcare plans (HDHPs) - which usually come with HSAs - for a number of reasons (click the link above to see why!). To find out why we’re worth it - check out www.directdoctors.org.
Lauren Hedde, DO and Mark Turshen, MD are Family Physicians and Founders of Direct Doctors, Inc. a Direct Primary Care Practice.