Proposed IRS Rule – Free Your Health Saving Account (HSA) for Direct Primary Care

But there is a catch…

Harking back to our earlier victory for DPC in Executive Order 13877 when the President ordered the IRS to:
“propose regulations to treat expenses related to certain types of arrangements, potentially including direct primary care arrangements and healthcare sharing ministries, as eligible medical expenses under Section 213(d)” of the Code.”,
the proposed new rules have been published in the Federal Register.

This is a good step forward to allow patients to use their HSA dollars to subscribe to a doctor, but there are serious problems that undermine the good intentions that will cripple DPC in the years to come.

TAKE ACTION – Please comment on the rule in the Federal Register ASAP.  We have crafted a sample letter that highlights the key problems.

Feel free to use it as your guide when you comment. Copy, edit, paste and submit to the Federal Register!

BELOW is a sample letter to use to comment BEFORE August 10, 2020



I am grateful the government is moving to allow citizens greater control over their Health Savings Account (HSA) dollars.  Adding Direct Primary Care (DPC) medical services provided by doctors is long overdue as an HSA Qualified Medical Expense.

In a system that has grown over decades to a dizzying size and complexity, subscribing to a local doctor for medical services creates a simple path for patients to get immediate low cost care.

However, there is a risk in the rule.  By identifying Direct Primary Care as a health plan, the rule opens the door to an avalanche of regulatory control. The reason Direct Primary Care works so well for doctors and patients is that it opts out of these layers of bureaucracy. 

By defining Direct Primary Care medical subscription services as a health plan, it opens these independent doctor’s offices across the nation to the regulatory control of State insurance commissioners.

Direct Primary Care is NOT A RISK BEARING ENTITY. It is an agreement to provide health care services provided by a doctor to a patient.  Patients must continue to maintain health insurance for catastrophic care – something outside the scope of the local doctor’s office (and Direct Primary Care).

The old adage, an ounce of prevention is worth a pound of cure, is the sweet spot for Direct Primary Care.  By maintaining the business freedom of Doctors, Direct Primary Care is a medical service that is incentivized to provide high quality care for the lowest price the market will bear.

80% of all health care issues can be resolved through a local doctor’s office.  Patients who see a DPC physician have a +40% reduction in ER utilization and a +19% reduction in hospitalization.

No further regulation is needed beyond that already provided by State licensure, OSHA, standards of care enforced via malpractice law, etc.

Using HSA dollars for medical service subscriptions is a private business partnership between a patient and their doctor.

• Please DO NOT define Direct Primary Care as a health plan.

• Please DO NOT put limitations on how the HSA dollars are spent beyond going to licensed health care providers.

• Please ALLOW personal contributions to HSAs when a patient has a Direct Primary Care doctor. Under the current rule, Direct Primary Care is considered a second health plan and thereby patients are prohibited from making their own HSA contributions – which is self defeating for the goal of the rule – expanding low cost, high quality care to rural and underserved communities.