Direct Primary Care Calculator
The membership, the care you expect, and your plan
Your result will appear here
Fill in the fields on the left and this updates as you type.
Know what this estimate is based on
- Jurisdiction
- General mathematical model
- Scope and limitations
- Educational estimate only. Confirm the assumptions, current rules, fees, and rounding that apply to your situation before making a decision.
- Source links checked
- Jul 30, 2026
Built and regression-tested by Smart Tools Lab. It has not been individually reviewed by a licensed financial, tax, or legal professional.
How to use
- 01
Enter the monthly membership fee. The page checks it against the $150 monthly limit that decides whether the arrangement can sit beside a health savings account.
- 02
Enter the primary care visits you expect in a year and what each one costs under your plan — the copay, or the contracted price if you have not met your deductible, which for most high-deductible plans is what a visit actually costs.
- 03
Value anything the membership includes that you would otherwise pay for separately, such as routine labs, and enter it as included services.
- 04
If you would pair the membership with a cheaper insurance plan, enter the yearly premium that move saves. Leave it at 0 if you would keep the plan you have, so the comparison stays honest.
- 05
Read the break-even number of visits and the schedule, which prices both routes from no visits to two dozen. The HSA line shows what the fee is worth after tax when the arrangement qualifies.
Formula
Two routes to the same primary care, priced over a year: Membership a year = monthly fee × 12 Membership, net = Membership a year − premium saved by pairing it with a cheaper plan Insurance-billed = visits × price per visit + services the membership includes What the membership saves = Insurance-billed − Membership, net The crossover is the visit count at which the two are equal: Break-even visits = (Membership, net − included services) ÷ price per visit The tax treatment is a cliff, not a taper: If monthly fee ≤ $150 ($300 where the arrangement covers more than one person), the arrangement qualifies: HSA eligibility survives and the fee is a qualified medical expense, worth (Membership a year × your marginal rate). If monthly fee > the limit, the arrangement is not a direct primary care service arrangement at all, and enrolling in it ends HSA eligibility. The limit is indexed for inflation for tax years after 2026 (IRS Notice 2026-5, §223(c)(1)(E)).
Example
Take an $85 a month membership, six primary care visits a year that would cost $40 each under your plan, $300 of routine labs the membership includes, $600 of yearly premium saved by pairing it with a cheaper plan, and a 22% marginal rate. The membership costs $1,020 a year, or $420 after the premium saving. Insurance-billed primary care comes to $540 — six visits at $40 plus the $300 of labs. The membership therefore saves $120 a year, and the break-even is 3.0 visits: the schedule shows the membership behind by $120 at no visits at all, level at around three, ahead by $120 at six, and ahead by $840 at 24. Because $85 is inside the $150 monthly limit, the arrangement qualifies, HSA eligibility survives, and the $1,020 of fees is a qualified medical expense worth $224 at a 22% rate — bringing the real cost of the year to $196. Rerunning the same page at $175 a month shows how sharp the cliff is. The membership becomes $2,100 a year, or $1,500 net, which loses $960 a year against the same $540 of insurance-billed care and pushes the break-even out to 30 visits. The HSA benefit falls from $224 to nothing, because above the limit the arrangement is not a qualifying one at all and enrolling in it would end eligibility to contribute.
Definitions
- Direct primary care service arrangement (DPCSA)
- An arrangement providing only primary care from primary care practitioners, where the sole compensation is a fixed periodic fee. Defined in §223(c)(1)(E), added by section 71308 of Public Law 119-21.
- Monthly fee limit
- $150 a month for one person, $300 where the arrangement covers more than one, for 2026. Fees above it take the arrangement outside the definition entirely rather than capping the benefit. Indexed for tax years after 2026.
- Qualified medical expense
- A cost an HSA can pay tax-free. From 2026 a direct primary care fee counts, because §223(d)(2)(C) was amended so the fee is not treated as the insurance an HSA may not buy.
- Primary care practitioner
- Defined by reference to the Social Security Act as a physician in family, internal, geriatric or pediatric medicine, or a nurse practitioner, clinical nurse specialist or physician assistant.
- Disqualifying coverage
- Any other health plan that provides benefits before the high-deductible plan's minimum deductible is met. Holding it ends HSA eligibility, which is what a membership above the monthly limit becomes.
Good to know
What a direct primary care membership actually is
Direct primary care is a way of paying a family doctor that removes insurance from routine visits entirely. Instead of billing a plan for each appointment, the practice charges a flat periodic fee and provides an agreed set of primary care services for it. IRS Notice 2026-5 describes the model as typically charging a fixed periodic fee for an array of primary care services and items such as physical examinations, vaccinations, urgent care, laboratory testing, and the diagnosis and treatment of some sicknesses and injuries. Patients usually report longer appointments, direct contact with the doctor and no copay at the point of care, because the fee has already covered it. What a membership is not is insurance. It pays nothing towards a hospital stay, an operation, a specialist or a prescription, and anyone holding one still needs a health plan for everything beyond primary care. That is why the page asks for the premium difference from pairing a membership with a cheaper plan rather than from dropping coverage: the honest comparison is primary care against primary care, with real insurance underneath either way. The economics are simple and depend almost entirely on how often you see a doctor. At the page's example of $85 a month, six visits a year at a $40 copay, $300 of included labs and $600 of premium saved by moving to a cheaper plan, the membership costs $420 net against $540 of insurance-billed care, saving $120 a year. The break-even is three visits. Someone who sees a doctor once a year is paying for availability they will not use; someone managing a chronic condition with monthly contact is getting a great deal. The schedule on the page runs the comparison from no visits to twenty-four so you can find yourself on it.
The 2026 change that let a membership sit beside an HSA
Until 2026 a direct primary care membership and a health savings account were close to incompatible, and the reason was technical rather than deliberate. To contribute to an HSA you must hold a qualifying high-deductible plan and no other health plan that pays before the deductible is met. A membership providing primary care for a flat fee looks exactly like such a plan, and as Notice 2026-5 explains, it generally would constitute a health plan providing coverage before the minimum annual deductible is satisfied that is neither disregarded coverage nor preventive care. So enrolling in one ended HSA eligibility. Section 71308 of Public Law 119-21, enacted on 4 July 2025, added §223(c)(1)(E) and fixed this in two places at once. First, a qualifying direct primary care service arrangement is no longer treated as a health plan for the purpose of the rule that limits eligible individuals to those with no other coverage, so enrolling does not disqualify you. Second, it amended §223(d)(2)(C) so the fee is not caught by the rule preventing an HSA from paying for insurance, which makes the fee a qualified medical expense an HSA can pay tax-free. Both apply to months beginning after 31 December 2025. On the example that turns $1,020 of yearly fees into $224 of tax saved at a 22% rate, bringing the real cost of the membership down to $196 once the premium saving is counted. The same act made bronze and catastrophic Marketplace plans count as high-deductible plans from 2026, which pairs naturally with this change: a cheap catastrophic plan for the serious risks, a membership for routine care, and an HSA funded alongside both.
A cliff, not a cap: the $150 limit
The most important thing to understand about the new rule is the shape of its limit, because getting it wrong is expensive. The statute says the term direct primary care service arrangement does not include any arrangement if the aggregate fees for an individual for a month exceed $150, or $300 for an arrangement covering more than one individual. Read that carefully: it does not cap how much of the fee is a qualified medical expense, and it does not allow the first $150 and disallow the rest. It removes the arrangement from the definition entirely. A membership at $151 a month is not a direct primary care service arrangement at all, which means it goes back to being ordinary other coverage — and enrolling in it ends your eligibility to contribute to an HSA completely, not partially. The page shows the discontinuity by rerunning the example at $175 a month: the HSA benefit drops from $224 to nothing, and because the fee has doubled while the care has not, the membership goes from saving $120 a year to costing $960, with the break-even pushed out to thirty visits. The limit is indexed for inflation for tax years after 2026, so the figure will move, but the cliff will not become a taper. Billing frequency is more flexible than the monthly limit suggests. Notice 2026-5 confirms an arrangement may charge for periods longer than a month and up to a year provided the fees are fixed, periodic and stay inside the limit once annualised, giving 2026 examples of $1,800 for a year, $900 for six months and $450 for three. What matters is the annualised total, so a practice billing quarterly is fine while one whose yearly total exceeds $1,800 for one person is not.
Whether your membership qualifies is a question about the contract
A membership that looks like direct primary care may still fail the definition, and the tests turn on the terms of the arrangement rather than on the care you happen to use. The first test is that the sole compensation for the care must be the fixed periodic fee. Notice 2026-5 confirms at Q&A-11 that an arrangement charging a membership fee but also billing separately for the items and services it provides, through insurance or otherwise, is not a qualifying arrangement. A practice that charges a monthly fee and then bills your plan for each visit has not created a direct primary care service arrangement, whatever it calls itself. Q&A-12 draws the useful distinction: if the practice offers other services outside the arrangement to members and non-members alike and bills those separately, the arrangement itself can still qualify. The second test is that you cannot cure a defect by behaving well. Q&A-14 states that whether an arrangement qualifies depends on its terms, not the services used by an individual, so declining the extras a membership offers does not rescue one that offers too much. The third test is what counts as primary care. The definition excludes procedures requiring general anesthesia, prescription drugs other than vaccines — vaccines themselves are permitted — and laboratory services not typically administered in an ambulatory primary care setting. A membership bundling in surgical procedures or a drug benefit is therefore outside the definition. The practical advice is dull but sound: read the membership agreement before assuming the tax treatment, and if HSA eligibility matters to you, ask the practice directly whether its arrangement is intended to meet §223(c)(1)(E). The agreement and your plan documents decide the real answer, not this page, and what care you actually need is a matter for you and your doctor.
Frequently asked questions
Can I have a direct primary care membership and still contribute to an HSA?
From 1 January 2026, yes, if the fee stays inside the limit. Section 71308 of Public Law 119-21 added §223(c)(1)(E), and IRS Notice 2026-5 explains it: a qualifying arrangement is not treated as a health plan that would disqualify you, and the fee is no longer treated as insurance, so an HSA can pay it. Before this change, enrolling in a membership generally ended HSA eligibility, because it provided care before the deductible was met.
How much can the membership fee be?
Up to $150 a month for one person, or $300 a month for an arrangement covering more than one, and the limit is indexed for inflation for tax years after 2026. Treat it as a cliff rather than a ceiling. The statute says the term direct primary care service arrangement does not include an arrangement whose monthly fees exceed the limit, so a membership a dollar over is not a qualifying arrangement at all — it counts as other coverage and ends HSA eligibility entirely. Rerunning the page at $175 a month removes the whole $224 of HSA tax benefit.
Is direct primary care cheaper than using insurance?
It depends entirely on how much primary care you use. At the page's example — $85 a month, six visits a year at a $40 copay, $300 of included labs and $600 of premium saved by pairing it with a cheaper plan — the membership costs $420 net against $540 of insurance-billed care, so it saves $120 a year. The break-even is 3.0 visits: below that the membership costs more, above it the membership costs less. At $175 a month the break-even jumps to 30 visits a year, which almost nobody reaches.
Can the practice bill me quarterly or yearly?
Yes. Notice 2026-5 confirms that a qualifying arrangement may charge for periods longer than a month and up to a year, provided the fees are fixed, periodic and stay inside the limit once annualised. Its own 2026 examples are $1,800 for a year, $900 for six months and $450 for three months. What matters is the annualised total, not the billing cycle.
What counts as a qualifying arrangement?
The test is the contract, not the care you use. The sole compensation must be the fixed periodic fee, so an arrangement that charges a membership and also bills separately for the items it provides is not a qualifying arrangement. The IRS also says whether an arrangement qualifies depends on its terms rather than the services an individual uses, so declining extras does not rescue a membership that offers them. Primary care services exclude procedures needing general anesthesia, prescription drugs other than vaccines, and laboratory services not usually done in a primary care setting.
Does a membership replace health insurance?
No, and nothing on this page treats it as though it does. A membership buys routine primary care and pays nothing towards a hospital stay, an operation or a specialist. The premium saving in the example comes from moving to a cheaper plan you still hold, not from dropping coverage. Pairing a membership with a bronze or catastrophic plan is a common approach, and from 2026 those plans can themselves be treated as high-deductible plans for HSA purposes.
Can I pay the fee from my HSA?
Yes, when the arrangement qualifies. The same section amended §223(d)(2)(C) so a direct primary care fee is not caught by the rule that stops an HSA paying for insurance, which makes the fee a qualified medical expense. In the example that turns $1,020 of yearly fees into $224 of tax saved at a 22% rate, bringing the real cost of the membership down to $196 once the premium saving is counted.