Reimbursement is the sole decision of your insurer. Concierge Pediatrics is here to provide education and assistance to help connect you with reimbursement opportunities.
HSA, FSA & Insurance: Paying for Concierge Pediatrics with Pre-Tax Dollars
For years, the answer to “can I pay my concierge pediatrician with my HSA?” was no. As of January 1, 2026, that answer changed. Under the One Big Beautiful Bill Act, families can now use Health Savings Account funds tax-free to pay direct primary care membership fees, up to $150 per month for one person or $300 per month for more than one. Here’s what the new rules can mean for your family.
What changed in 2026
Before this year, the IRS treated membership fees for direct primary care and concierge practices as a fee for access rather than for medical care. That meant you couldn’t pay them with HSA funds, and in some cases having a membership could even jeopardize your ability to contribute to an HSA at all.
The One Big Beautiful Bill Act, with IRS guidance issued in Notice 2026-05, changed both problems. Beginning January 1, 2026:
- You can stay HSA-eligible while enrolled in a qualifying direct primary care arrangement. Membership no longer blocks you from contributing to your HSA.
- You can pay qualifying membership fees with HSA funds, tax-free. The fees are now treated as qualified medical expenses.
For a family in a typical combined federal and New York or New Jersey tax bracket, paying with pre-tax dollars is the equivalent of a meaningful discount on the membership itself.
The fine print that matters
The new rules come with conditions, and an honest practice will tell you about them:
The fee caps. The tax-free treatment applies to direct primary care fees up to $150 per month for an individual, or $300 per month total when the arrangement covers more than one person. These caps are why our core membership is priced at $150 per month per child. Fees above the caps don’t get the same treatment, so families enrolling several children should review how the aggregate limit applies to them with their benefits administrator.
What counts as direct primary care. The arrangement must consist of primary care services provided by primary care practitioners in exchange for a fixed periodic fee. Practices that bill your insurance on top of charging membership fees generally don’t qualify. Our membership model, a flat monthly fee covering your child’s primary care with no insurance billing, is the structure this law was written for.
Not everything is covered by the caps. Optional extras billed separately, like in-home sick visits, are outside the fixed membership fee. Whether those qualify as ordinary medical expenses is a separate question, and usually they do, since they’re direct payments for medical care.
How to actually do it
- Confirm your HSA eligibility. You need an HSA-compatible health plan. New for 2026: bronze and catastrophic marketplace plans now count, which expands who can open and fund an HSA.
- Pay the membership fee, then reimburse yourself from your HSA (or pay directly with your HSA debit card). Keep your membership agreement and receipts.
- Ask your benefits administrator about your FSA. Now that qualifying DPC fees are treated as qualified medical expenses, many FSA plans can reimburse them too, but FSA rules vary by employer, so confirm before counting on it.
When in doubt, a 10-minute conversation with your benefits administrator or tax advisor settles your specific situation. We’re happy to provide the documentation they’ll ask for.
What about insurance?
Membership and insurance work together, not instead of each other:
- Keep your insurance for hospital care, specialists, and emergencies. Membership covers your child’s primary care relationship with us.
- Superbills for out-of-network reimbursement. Because we don’t bill insurance directly, we provide itemized superbills you can submit to your insurer. Depending on your out-of-network benefits, you may recover a portion of your costs. [INTERNAL LINK: /superbills “insurance reimbursement and superbills”]
- The stack, combined: pre-tax HSA dollars for the membership fee, insurance for everything beyond primary care, and superbills where your plan allows. That’s the full picture of what concierge pediatric care actually costs after tax treatment, and it’s considerably less than the sticker price suggests.
A worked example
A family with one child and an HSA-compatible plan pays $150/month for a Concierge Pediatrics HSA “core” membership, $1,800 per year. Paid with pre-tax HSA dollars at a 30% combined marginal rate, the effective cost is roughly $1,260, about $105 per month, for 24/7 communication access to their pediatrician, same-day and next-day visits, comprehensive annual physicals, and as many sick visits as needed.
FAQ
Can I use my HSA to pay for a concierge pediatrician in 2026?
Yes, if the practice qualifies as a direct primary care arrangement: primary care services for a fixed periodic fee, with fees up to $150/month for one person or $300/month for more than one. The change took effect January 1, 2026 under the One Big Beautiful Bill Act.
Does a concierge membership stop me from contributing to my HSA?
Not anymore. As of 2026, enrollment in a qualifying DPC arrangement no longer affects your HSA eligibility, provided fees stay within the monthly caps.
Can I use an FSA for concierge pediatric fees?
Possibly. Qualifying DPC fees are now treated as qualified medical expenses, but FSA coverage depends on your employer’s plan terms. Confirm with your benefits administrator.
What if I have three or more children enrolled?
The $300/month cap applies to arrangements covering more than one individual. How the aggregate limit interacts with multiple separate memberships is a question for your tax advisor; we can provide the fee documentation they’ll need.
Do superbills still matter now that HSA payment is allowed?
Yes. HSA treatment and out-of-network insurance reimbursement are separate. Superbills can recover a portion of costs from your insurer on top of the tax savings, depending on your plan.
The bottom line
For the first time, families can pay for a concierge pediatric membership with pre-tax dollars. The law was effectively written for the model we practice: a flat monthly fee, no insurance billing, just primary care. If you want to understand what your family’s real after-tax cost would be, talk to our team and bring your benefits questions; we’ll give you straight answers and the paperwork your administrator needs.
Still feel confused about how insurance works with a membership model healthcare office, like Concierge Pediatrics? This webinar breaks down out-of-network benefits, reimbursement options, and recent policy updates so you can confidently use both personalized care and your insurance. Learn about how to maximize your insurance benefits to cover your concierge care and more from Shari Resnick and Lindsay Rosen from R Partner in Care Health Insurance Advocates.