Maximizing Your DPC Membership Value
How Direct Primary Care fits with insurance, Medicare, Medicaid, and health sharing plans — and the smartest ways to pay for it
Please note: This guide is general education, not tax, legal, or insurance advice. Tax rules and insurance products change frequently — figures below are current for the 2026 tax year and were last reviewed July 16, 2026. Archangel Michael Health does not sell insurance, and we receive no compensation, referral fee, or commission from any insurance company, health sharing organization, or platform mentioned on this page. Please confirm your own situation with a tax professional and a licensed insurance broker before making decisions.
Understanding Direct Primary Care
What DPC Includes
- Unlimited office visits
- Extended appointments (30–60+ minutes)
- Same/next-day access
- 24/7 physician communication
- Chronic disease management
- Basic procedures & preventive care
What DPC Doesn’t Cover
- Specialist consultations
- Hospital admissions
- Emergency room visits
- Major surgeries
- Advanced imaging (MRI, CT)
- Cancer treatment
- Maternity/delivery care
- Physical therapy
Labs, imaging & medications: billed separately — on purpose
Your monthly fee covers primary care itself — the visits, access, and management above. Nothing else is ever bundled into it. Labs, imaging, and medications are separate, transparently priced costs, and here is how each works at our practice today:
- Labs & imaging: you can run these through your insurance as usual, or pay cash through the discount programs we use — Fullscript for laboratory testing (covering roughly 50 lab companies, including Quest and LabCorp) and Radiology Assist for imaging. To be clear, exactly as with medications below: these discounts are available to anyone whose physician uses these services — member or not. They are not a membership benefit, we don’t mark them up, and you pay those companies directly, outside your membership fee. Cash prices through them typically run one-tenth to one-quarter of “billed charges” — the list prices on hospital and lab chargemasters. Recent examples, not a price list: a brain MRI without contrast around $300 versus typical billed charges of $3,000 or more; a screening mammogram around $125 versus $600 or more; complete panels of routine labs often under $100 versus billed charges of $800–$1,000. One honest note about those comparisons: billed charges are sticker prices that most insured patients never actually pay — so what this is worth to you depends on your coverage. Your situation tab below gives the fair comparison for your case. What the membership adds here is a physician who knows these routes exist and takes the time to find you the cheaper one.
- Medications: we don’t run a dispensary. What we do is prescribe generics when they’re clinically appropriate and actively cost-shop with you using cash-price tools such as GoodRx, Cost Plus Drugs, and TrumpRx. To be clear: those tools are available to anyone, member or not. The membership benefit isn’t special drug pricing — it’s a physician who takes the time to do this work with you.
“I Already Have Insurance — Why Would I Pay Extra for DPC?”
This is the single most common question we hear, and it deserves a straight answer rather than a sales pitch.
Insurance and DPC solve different problems
Your insurance is financial protection: it exists so that a hospitalization or cancer diagnosis doesn’t bankrupt you. A DPC membership doesn’t duplicate that — it changes how your primary care actually works. Instead of 7-minute visits booked three weeks out, you get 30–60 minute appointments, same-day or next-day access, and a physician you can reach directly. Your insurance keeps doing its job for the big, rare, expensive events. The membership changes the everyday experience of being cared for.
So the honest framing is: you’re not paying twice for the same thing. You’re paying your insurer for protection, and you’re paying us for time, access, and continuity that insurance-based primary care rarely delivers — regardless of how good your plan is.
The honest math
A membership costs real money — $55 to $200 a month depending on your age and family size. Whether it saves you money depends on your situation:
- If you have a high-deductible plan, you were probably paying cash for primary care visits anyway. DPC often replaces those costs with a lower, predictable one — and since 2026 you can usually pay the fee with pre-tax Health Savings Account (HSA) dollars (details below).
- If you have a rich, low-deductible plan and see a doctor once or twice a year, DPC will probably not pay for itself in dollars. What you’d be buying is access and time, and it’s fair to weigh whether that’s worth it to you.
- One number to know: your DPC fee never counts toward your insurance deductible or out-of-pocket maximum (IRS Notice 2026-5). When you compare costs, treat the membership as a pure add-on.
DPC tends to be worth it if you…
- Manage one or more chronic conditions that need regular attention
- Take multiple medications that need ongoing review and coordination
- Have a high deductible and pay cash for most primary care anyway
- Value long appointments and a real relationship with your physician
- Want same-day or next-day access instead of weeks-long waits
- Are self-employed or run a small business and buy your own coverage
- Are frustrated with rushed, referral-driven, insurance-based care
DPC is probably not worth the extra cost if you…
- Rarely need a doctor (fewer than 2–3 visits a year) and have low-deductible coverage you like
- Get most of your care from specialists rather than primary care
- Would have to give up catastrophic protection to afford the membership — keep the catastrophic protection first
We’d rather tell you the truth than make a sale. We built a calculator that runs your actual numbers — age, coverage, visit patterns, medications — and it will sometimes tell you that keeping your current setup without DPC is the better financial choice. If the numbers don’t work for you, we’d rather you know that now.
What Membership Costs — and the 2026 Tax Win
| Membership Tier | Monthly Fee | Under the 2026 HSA cap? |
|---|---|---|
| Student | $55 | Yes ($150 individual cap) |
| Individual, age 18–49 | $75 | Yes ($150 individual cap) |
| Individual, age 50–64 | $90 | Yes ($150 individual cap) |
| Individual, age 65+ | $125 | Yes ($150 individual cap) |
| Couple | $150 | Yes ($300 multi-person cap) |
| Family + 1 child | $175 | Yes ($300 multi-person cap) |
| Family + 2 or more children | $200 | Yes ($300 multi-person cap) |
HSA Funds Can Now Pay for Your DPC Membership
On July 4, 2025, Congress enacted Public Law 119-21 (commonly called the “One Big Beautiful Bill Act”). Section 71308 amended Internal Revenue Code § 223 to formally recognize direct primary care service arrangements. The IRS explained how it works in Notice 2026-5.
For months beginning after December 31, 2025:
- Being enrolled in a qualifying DPC arrangement no longer disqualifies you from contributing to a Health Savings Account (HSA).
- DPC fees are a qualified medical expense you can pay directly from your HSA.
- This holds as long as the fee stays at or below $150/month for an arrangement covering one person, or $300/month for an arrangement covering more than one person (added up across all DPC arrangements you have). These limits apply for 2026 and are indexed for inflation in later years.
Before 2026
- A DPC membership generally made you ineligible to contribute to an HSA
- Whether HSA funds could reimburse monthly DPC fees was unsettled
- Most members paid DPC fees with after-tax dollars
From January 2026 ACTIVE
- A qualifying DPC membership no longer blocks HSA eligibility
- HSA funds can pay DPC fees directly (within the caps above)
- Bronze and Catastrophic plans available as individual coverage through the Marketplace are treated as HSA-qualified high-deductible plans (Public Law 119-21 § 71307) — and this holds even if you bought the plan off-Marketplace, so long as the same plan is available on it (Notice 2026-5, Q&A-6). Small-employer SHOP coverage is not individual coverage and doesn’t qualify under this rule.
Find Your Situation
The right way to think about DPC depends on the coverage you already have. Pick the tab that describes you. For each, we cover what DPC adds, what it duplicates, what it can’t do, and how to pay for it.
I Have Insurance Through My Job
What DPC adds: everything in the “why pay extra” section above — time, access, and continuity your plan doesn’t buy you, no matter how good it is.
What it duplicates: your plan already covers primary care visits (usually with a copay). As a member you’ll likely stop using that part of your plan, while keeping it for specialists, hospital care, imaging, and emergencies.
What it can’t do: major insurance carriers do not reimburse DPC membership fees, and the fees don’t count toward your deductible or out-of-pocket maximum. The membership is an addition to your plan, not a replacement for it.
Labs and imaging on a plan like yours: the cash prices through Fullscript and Radiology Assist are often cheaper than what you’d pay through insurance before you’ve met your deductible — but compare them against your plan’s negotiated rate (the price on your Explanation of Benefits), not the sticker-price “billed charge,” which insured patients rarely pay. Two honest caveats: cash payments don’t count toward your deductible or out-of-pocket maximum, and once your deductible is met, running labs or imaging through your insurance may well cost less than the cash price — we’ll tell you when that’s the case.
How to pay for it
- If your job offers a high-deductible health plan (HDHP) with an HSA: this is the best fit. Since January 2026 you can pay the membership straight from your HSA, pre-tax. See the accounts guide below.
- If you have a general-purpose health Flexible Spending Account (FSA): many FSA administrators reimburse DPC fees as a medical expense, but the IRS has never squarely confirmed it — ask your administrator in writing first. Note that having a general-purpose FSA also blocks HSA contributions. Details below.
- If your employer offers a Health Reimbursement Arrangement (HRA): HRAs can generally reimburse DPC fees. One important rule: if your employer pays your DPC fee — including through pre-tax payroll deduction under a § 125 cafeteria plan — you cannot also reimburse yourself from your HSA for the same fee (IRS Notice 2026-5). No double-dipping.
Worth asking your employer about
- Adding DPC as an employee benefit, or reimbursing it through an HRA, Individual Coverage HRA (ICHRA), or Qualified Small Employer HRA (QSEHRA)
- Offering an HSA-qualified high-deductible plan option
- “Level-funded” plans that carve primary care out of the group plan and fund DPC memberships with the savings — often better benefits at lower total cost for small employers
I Buy My Own Insurance (Healthcare.gov / Marketplace)
This is where DPC pairs most naturally: a lower-premium, high-deductible plan for catastrophic protection, plus DPC for everything day-to-day.
The strategy
- Choose an HSA-qualified plan for protection. For 2026, any Bronze or Catastrophic plan available as individual coverage through the Marketplace is treated as an HSA-qualified high-deductible plan (Public Law 119-21 § 71307) — even if its deductible or out-of-pocket numbers wouldn’t normally qualify. Helpfully, the test is whether the plan is available on the Marketplace, not whether you bought it there: an off-Marketplace Bronze plan still counts if the same plan is offered on it, and the IRS extends the same treatment where you had no reason to think it wasn’t (Notice 2026-5, Q&A-6 and Q&A-7). Small-employer SHOP coverage is the real exception — it isn’t individual coverage, so it doesn’t qualify under this rule (Q&A-8).
- Open and fund an HSA. 2026 limits: $4,400 individual / $8,750 family, plus $1,000 catch-up at 55+.
- Pay your DPC membership from the HSA, pre-tax, and use the rest for other qualified medical expenses.
- Reserve the insurance plan for specialists, hospitalizations, emergencies, and surgeries.
Labs and imaging: the same honest math applies here. On a high-deductible plan, the Fullscript and Radiology Assist cash prices usually beat your plan’s negotiated rates while you’re below the deductible — but cash payments don’t count toward that deductible or your out-of-pocket maximum, and once the deductible is met, insurance may cost less than the cash price. We’ll tell you when it does.
The 2026 premium reality, honestly: the enhanced federal premium subsidies that ran from 2021 through 2025 expired on December 31, 2025. For 2026:
- Florida marketplace premiums rose roughly 31.5% on average — among the steepest increases in the country.
- The “subsidy cliff” is back: households above 400% of the federal poverty level (about $62,600 for a single person for 2026 coverage) get no premium subsidy at all.
- At lower incomes the news is better than headlines suggest: cost-sharing-reduction Silver plans at 100–150% of the poverty level can carry very low deductibles.
One illustration, not a quote: for a single 28-year-old earning about $35,000 in Alachua County in 2026, the average Silver plan runs about $768/month before subsidy and roughly $363/month after (Florida Office of Insurance Regulation data). Your price will differ — often substantially — by age, income, household size, and plan. Check your real price at Healthcare.gov before deciding anything.
Catastrophic plans (2026 deductible: $10,600) are open to people under 30 — and, new for 2026, the hardship exemption was expanded to people who lost subsidy eligibility because their income is below 100% or above 400% of the federal poverty level. If the cliff hit you, a Catastrophic plan may be your cheapest protection, and through the Marketplace it now counts as HSA-qualified.
Open enrollment for 2026 coverage ran November 1 – January 15. Enrollment windows can change year to year — check Healthcare.gov for the current dates. DPC membership itself can start any month; there’s no enrollment period.
I’m on Medicare
What DPC adds: Medicare covers a great deal, but it doesn’t buy you long appointments, same-day access, or a physician who knows you and answers directly. For our 65+ members, that’s usually the point — DPC on Medicare is primarily an access and relationship decision, not a cost-savings play. Our own calculator will tell you the same thing.
What it duplicates and what it can’t do: your membership doesn’t replace Medicare, and it doesn’t change what you owe Medicare — the Part B premium ($202.90/month in 2026), the Part B deductible ($283), and your Part D drug plan all continue as before. Keep your Medicare.
How our practice works with Medicare
Our physician has formally opted out of Medicare — the standard, federally sanctioned arrangement (Social Security Act § 1802(b); 42 CFR 405.400–405.445) that lets a physician care for Medicare beneficiaries under a private membership agreement instead of Medicare billing. Opt-out status runs in two-year cycles and renews automatically. Here is what it means for you, stated plainly:
- Medicare pays nothing for the care we provide. Neither we nor you can submit a claim to Medicare for our services, and a Medigap (Medicare Supplement) policy won’t pay for them either. Your membership fee is what pays for your primary care here. That’s the tradeoff, and it deserves an honest weighing: you are giving up Medicare payment for our care specifically in exchange for the membership model.
- Everything else about your Medicare stays intact. Opting out applies only to care furnished by our practice. Hospital care, specialists, labs, imaging, home health, and your Part D drug plan remain covered exactly as before — and we can still order your tests, refer you to specialists, and certify care such as home health. Medicare pays for those covered services from other providers just as it always has.
- You’ll sign a private contract before we treat you. Federal rules (42 CFR 405.415) require a written agreement, signed in advance, acknowledging the points above: that neither of us will bill Medicare for our services, that Medicare’s fee limits don’t apply to them, that Medigap won’t pay for them, and that you always keep the right to see any other doctor who does bill Medicare. The rules don’t allow this contract to be signed during an emergency — so it happens at enrollment, calmly, with time for your questions.
If you’d rather your primary care be billed to Medicare, a membership with us isn’t the right fit — and we’ll tell you so. Some of our Medicare-age patients decide the time and access are worth paying for; some decide otherwise. Both are reasonable choices.
Paying for it: the HSA rules change at 65
What about a Medicare MSA?
A Medicare Medical Savings Account (MSA) plan is a type of Medicare Advantage plan that pairs a high-deductible plan with a savings account funded by Medicare itself — you cannot add your own money. Withdrawals for qualified medical expenses are tax-free; anything else is taxed plus a 50% penalty, and MSA plans never include drug coverage (you’d buy a separate Part D plan). On paper, it’s an interesting fit with DPC. In practice, two honest caveats:
- Availability: MSA plans have nearly vanished. For the 2026 plan year, only one insurer offers one, in Wisconsin — none are available in Florida. It’s worth a glance at the Medicare Plan Finder each fall, but don’t build a plan around it.
- Tax status: whether monthly DPC membership fees count as a qualified medical expense for MSA dollars isn’t squarely settled — the 2026 law that answered this for HSAs amended the HSA rules specifically. Ask a tax advisor before using MSA funds for membership fees.
See the accounts guide below for how MSAs compare to the other account types.
I’m on Medicaid
The honest headline: Medicaid already covers primary care at little or no cost to you, so a DPC membership will not save you money. What it buys is access — long appointments, same-day availability, direct communication, and one physician who follows your whole story. For some patients (especially those managing complex chronic conditions, or who struggle to find physicians accepting Medicaid) that access is worth paying for. For many others it isn’t, and we’ll say so.
- Keep your Medicaid. DPC is not a substitute for it. Medicaid remains your coverage for hospitals, specialists, medications, and emergencies.
- Paying for it: membership would come out of pocket ($55–$200/month). HSA strategies generally don’t apply, since Medicaid coverage isn’t compatible with HSA eligibility.
- A Florida note: Florida has not expanded Medicaid, so eligibility for non-disabled adults is narrow. If you’ve been told you earn too much for Medicaid but too little for Marketplace subsidies, see the “No coverage right now” tab — that situation is exactly what it covers.
Health Sharing Plans & Medical Crowdfunding
Please read this before choosing any health sharing plan. Health care sharing ministries and medical crowdfunding communities are not insurance. State insurance regulators do not supervise them, and they are not legally required to pay your bills — sharing is voluntary. Several large organizations have faced state enforcement actions, and at least one went bankrupt leaving members’ medical bills unpaid. Colorado — the only state that collects this data — found that roughly 45 cents of every dollar members submitted to sharing organizations in 2024 was ruled ineligible for sharing.
Many of our patients still choose these plans, pair them with DPC, and are happy with the combination — the monthly cost can be far below insurance. But go in with your eyes open, read the current guidelines yourself, and consider talking to a licensed insurance broker first.
Why people pair them with DPC: sharing plans typically do not cover routine primary care at all — they’re built for large, unexpected medical events. DPC fills exactly that gap, which is why several sharing organizations publish DPC-specific provisions. Examples of the category include Medi-Share, Christian Healthcare Ministries, Samaritan Ministries, Liberty HealthShare, Zion HealthShare, and Sedera; CrowdHealth is a secular crowdfunding community built on a similar not-insurance model. Most (but not all) sharing ministries require members to affirm a statement of Christian faith and follow lifestyle rules.
We deliberately do not publish these organizations’ benefit amounts or prices here. Their terms change frequently, they differ by plan level, and we cannot verify or vouch for them. We do not endorse or recommend any particular organization, and we receive no compensation, referral fee, or commission from any of them — we describe these options because patients ask about them, not because we’re paid to. What we can give you is the checklist we’d use ourselves.
How to evaluate any health sharing plan — the questions that matter
- Get the current member guidelines in writing. The guidelines document — not the marketing page, not a broker’s summary — is the actual deal. If you can’t easily get it, that tells you something.
- Ask exactly what the DPC benefit is, and what triggers it. Is it a monthly amount? A credit toward your unshared amount? Shareable only during a qualifying medical event? Get the answer with a guideline section number, in writing. These provisions vary enormously and change often.
- Read the pre-existing condition rules. How is “pre-existing” defined? Waiting periods of 12–36 months are common; some chronic conditions (diabetes, heart disease, cancer history) may be permanently excluded.
- Find the unshared amount. How much do you pay per incident (and per year) before anything is shared? Is it per person or per household?
- Check maternity, mental health, and prescription rules. These are the three areas most often limited or excluded.
- Ask about the organization’s track record. What percentage of submitted bills was ruled eligible last year? Is there an independent appeal process? (There is no state-regulator appeal, because no state regulator supervises them.)
- Search your state insurance department and attorney general for enforcement actions involving the organization before you join.
- Ask what happens to unpaid bills if the organization shuts down. There is no guaranty fund behind a sharing plan the way there is behind an insurance company.
- Understand the faith and lifestyle requirements and whether you can honestly meet them — misrepresenting them can void your membership when you most need it.
- Compare against a real insurance quote before deciding. Depending on your income, a subsidized Marketplace Bronze plan may cost less than you assume — and it comes with a legal obligation to pay claims. Check Healthcare.gov first.
Tax note: there is no federal or Florida tax penalty for using a sharing plan instead of insurance (details below). HSA dollars generally cannot pay sharing-plan contributions, and sharing membership alone doesn’t make you HSA-eligible.
I Have No Coverage Right Now
What DPC gives you: a real front door to healthcare at a known monthly price ($75/month for most adults), with no insurance required — unlimited visits, chronic disease management, and a physician you can actually reach. For uninsured patients, this is often the strongest value on this entire page.
And the cash-price routes matter most here. Without insurance, you’re the person who can actually be handed the full “billed charge” — and the cash prices through Fullscript (labs) and Radiology Assist (imaging), billed separately from the membership fee, typically run one-tenth to one-quarter of those charges. Recent examples, not a price list: a brain MRI without contrast around $300 versus billed charges of $3,000 or more; a screening mammogram around $125 versus $600 or more; complete panels of routine labs often under $100 versus $800–$1,000. Ask us for current pricing. As above, these discounts are open to anyone whose physician uses these services — what the membership adds is a doctor who routes you to them.
Your options for the catastrophic layer, in order to check them
- Check Healthcare.gov first. If your household income is between 100% and 400% of the federal poverty level (for 2026 coverage: about $15,650–$62,600 for a single person), you qualify for premium subsidies — possibly larger than you expect at lower incomes.
- Catastrophic plans (2026 deductible: $10,600) if you’re under 30 — or, new for 2026, if you qualify for the expanded hardship exemption because your income is below 100% or above 400% of the poverty level.
- Health sharing or crowdfunding — genuinely cheaper monthly, genuinely weaker guarantees. Read the Health sharing tab and its checklist first.
The Alphabet Soup: HSA, FSA, HRA & MSA Explained
Four kinds of tax-advantaged accounts can come up when paying for a DPC membership: the Health Savings Account (HSA), the Flexible Spending Account (FSA), the Health Reimbursement Arrangement (HRA) and its small-employer cousins, and the Medical Savings Account (MSA). They sound alike and work very differently. Here’s each one, in plain language, with the DPC rules for 2026.
HSA — Health Savings Account (the best fit for most)
What it is: a savings account you own, forever, regardless of employer. Money goes in pre-tax, grows tax-free, and comes out tax-free for qualified medical expenses — the only triple-tax-advantaged account in the U.S. tax code. Unused money rolls over every year and can be invested.
Who can contribute: you must be covered by an HSA-qualified high-deductible health plan (HDHP) (2026 minimum deductible: $1,700 individual / $3,400 family; maximum out-of-pocket $8,500 / $17,000), have no disqualifying other coverage, not be enrolled in Medicare, and not be claimable as a dependent.
2026 contribution limits: $4,400 individual / $8,750 family, plus a $1,000 catch-up at age 55+.
DPC rules (new for 2026): a qualifying DPC membership no longer blocks HSA eligibility, and you can pay the fee straight from the HSA — as long as the fee is at or below $150/month for one person or $300/month for more than one (all our tiers qualify). If a fee ever exceeded those caps, it would stay reimbursable but would block new contributions while enrolled (Notice 2026-5, Q&A-20).
Watch out: enrolling in any part of Medicare ends your ability to contribute (you can still spend). And if your employer pays your DPC fee — including pre-tax through payroll — you can’t also reimburse it from your HSA.
Doing it in practice: (1) confirm your plan is HSA-qualified for 2026; (2) put your membership on your HSA card, or pay personally and reimburse yourself; (3) keep receipts; (4) consider raising payroll HSA contributions to cover the fee.
FSA — Flexible Spending Account (check before you count on it)
What it is: an employer-sponsored account funded from your paycheck pre-tax. Unlike an HSA, your employer owns the plan: the money doesn’t follow you when you leave, and it doesn’t roll over freely.
2026 limit: $3,400 in salary-reduction contributions.
Use it or lose it: FSA money must generally be spent within the plan year. Employers may offer either a carryover (up to $680 into 2027) or a grace period of up to 2.5 months — not both, and some offer neither. Check your plan documents.
Can it pay DPC fees? Honestly: usually, but confirm first. Many FSA administrators reimburse DPC membership fees as a medical expense, and IRS proposed regulations from 2020 treat DPC fees as medical care — but the 2026 law that settled this question for HSAs amended the HSA rules specifically, and the IRS has never issued a squarely-on-point “yes” for health FSAs. Ask your administrator in writing before you count on it.
The big trap: a general-purpose health FSA counts as disqualifying coverage — it blocks HSA contributions for you and your spouse for the whole plan year (even a leftover carryover balance can). A limited-purpose FSA (dental and vision only) does not block HSA eligibility — but it also can’t pay DPC fees. You generally can’t run both the FSA strategy and the HSA strategy at once; for most of our members the HSA wins.
HRA, ICHRA & QSEHRA — when your employer pays
What they are: arrangements where the employer (never the employee) funds tax-free reimbursement of medical expenses.
- HRA — Health Reimbursement Arrangement: the general form, paired with a group health plan. Can typically reimburse DPC fees if the plan document allows.
- ICHRA — Individual Coverage HRA: employer gives a tax-free allowance toward individual-market insurance and medical expenses. No dollar limit; any size employer; the employee must maintain qualifying individual coverage.
- QSEHRA — Qualified Small Employer HRA: for employers with fewer than 50 employees, no group plan required. 2026 limits: $6,450 individual / $13,100 family. Employee must have minimum essential coverage.
Two rules that trip people up:
- No double-dipping: DPC fees your employer pays — including your own pre-tax dollars routed through a § 125 cafeteria plan — are not expenses your HSA can also reimburse (IRS Notice 2026-5).
- HRA vs. HSA: a general-purpose HRA that reimburses DPC fees or other medical expenses generally makes you ineligible to contribute to an HSA. Only limited-purpose or post-deductible HRA designs preserve HSA eligibility. If your employer offers both, the plan design matters — have them confirm it.
MSA — Medical Savings Accounts (mostly historical, one exception)
Archer MSA: the 1990s predecessor of the HSA, for the self-employed and small employers. It has been closed to new participants since 2007 (existing account holders, and employees of the few small employers still running them, can continue). If you have one, the money remains yours and spends much like HSA money — ask a tax advisor about DPC fees specifically. If you don’t have one, you can’t open one; the HSA replaced it.
Medicare MSA: a type of Medicare Advantage plan pairing a high-deductible plan with an account Medicare itself funds each year — you cannot contribute your own money. Unused deposits roll over; withdrawals for qualified medical expenses are tax-free, while non-medical withdrawals are taxed plus a 50% penalty. MSA plans never include drug coverage (a separate Part D plan is needed).
The honest 2026 status: Medicare MSA plans have nearly disappeared — for 2026 a single insurer offers one, only in Wisconsin. None are available in Florida. And whether monthly DPC fees are a qualified expense for MSA dollars isn’t squarely settled, since the 2026 law addressed HSAs specifically. It’s worth checking the Medicare Plan Finder each fall in case the market returns, but for now, the practical path for our 65+ members is spending down an existing HSA.
Side by side
| Account | Who can have one | Who funds it | Can it pay DPC fees? | Effect on HSA eligibility | At 65 / on Medicare |
|---|---|---|---|---|---|
| HSA | Anyone with an HSA-qualified high-deductible plan and no disqualifying coverage | You, your employer, or anyone (2026: $4,400 / $8,750 + $1,000 at 55+) | Yes — tax-free, for fees up to $150/$300 a month (all AMH tiers qualify) | — | Contributions stop at Medicare enrollment; tax-free spending continues, including DPC fees and most Medicare premiums |
| Health FSA (general purpose) | Employees whose employer offers one | You, pre-tax via payroll (2026: $3,400); employer may add | Usually — confirm with your plan administrator in writing | Blocks HSA contributions for you and your spouse | Tied to your job, not to Medicare |
| Limited-purpose FSA | Employees whose employer offers one | You, pre-tax via payroll | No — dental and vision expenses only | No effect | Tied to your job |
| HRA / ICHRA / QSEHRA | Employees whose employer offers one | Employer only (QSEHRA 2026: $6,450 / $13,100) | Often yes, if the plan document allows | A general-purpose HRA covering DPC usually blocks HSA contributions; employer-paid fees can’t also be HSA-reimbursed | Employer-dependent |
| Archer MSA | Closed to new participants since 2007 | You or your employer (existing accounts) | Existing accounts: ask a tax advisor | Has its own eligibility rules — ask a tax advisor | Contributions stop at Medicare enrollment |
| Medicare MSA | Medicare beneficiaries where a plan is offered (2026: one insurer, Wisconsin only — none in Florida) | Medicare only — you cannot add money | Qualified medical expenses, yes; DPC fees not squarely settled — ask a tax advisor | Not applicable — you’re on Medicare | This is a Medicare option |
Florida Law & Tax Questions
Florida’s DPC law — what it actually says
Florida Statute § 624.27 — “Direct health care agreements; exemption from code” (enacted 2018 as HB 37; amended through 2025) establishes that direct health care agreements are not insurance and are not subject to the Florida Insurance Code. In practice:
- DPC practices don’t need an insurance license to offer a membership agreement — § 624.27(3).
- The agreement must be in writing, describe the scope of services covered by the monthly fee, and specify the fee plus any charges for services not covered — § 624.27(4)(a), (d), (e).
- Either party may end the agreement with at least 30 days’ written notice; the agreement may allow immediate termination for a breach of its terms or of the physician–patient relationship — § 624.27(4)(c).
- If the provider stops offering services, prepaid fees must be refunded — § 624.27(4)(g).
- The agreement must carry a conspicuous disclosure (contrasting color, 12-point type, on the signature page) stating that it is not health insurance and does not satisfy the Affordable Care Act’s minimum essential coverage requirement — § 624.27(4)(h).
Separately — and as a matter of federal rather than Florida law — DPC fees do not count toward an insurance plan’s deductible or out-of-pocket maximum (IRS Notice 2026-5, Q&A-16).
Will I owe a tax penalty for not having insurance?
A common question from patients considering health sharing plans or going without coverage:
- Federal: the federal tax penalty for not having qualifying health insurance (the Affordable Care Act’s “individual mandate”) was reduced to $0 starting with tax year 2019, and remains $0 for 2026.
- State: as of the 2026 tax year, none of the states we serve — Florida, Georgia, Texas, Arizona, North Carolina, Tennessee, and New Hampshire — imposes its own individual mandate penalty.
Bottom line: as of 2026, neither the federal government nor any state we serve imposes a tax penalty for going without ACA-qualifying coverage. Tax law changes — confirm your own situation with your tax preparer. And note that a handful of states (Massachusetts, New Jersey, California, Rhode Island, and the District of Columbia) do have individual mandates, so different rules apply if you move.
Other tax notes: HSA-paid DPC fees are pre-tax (see the accounts guide); Florida has no state income tax, so HSA contributions reduce your federal taxable income dollar-for-dollar with no state-level complications.
Additional Resources
Our Tools
- DPC Savings Calculator — run your own numbers
- Direct Primary Care in Gainesville — how membership works, by house call or by telehealth in every state we serve
- Integrative Medicine in Gainesville — our whole-person approach, in person or by telehealth
- Patient Application
- Frequently Asked Questions
- Contact Us / Request a Call
Official Resources
Questions Worth Asking
- Your employer — about HRA, FSA, and HSA options
- A licensed insurance broker — about DPC-compatible plans
- Any health sharing organization — the ten questions in our checklist above
- Your tax advisor — about HSA timing, especially near age 65
Ready to See Your Numbers?
Run your own situation through our calculator — it will give you an honest answer either way. If DPC makes sense for you, the application takes a few minutes.
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Disclaimer: This guide is for general education only. It is not tax, legal, or insurance advice, and it is not a complete description of any insurance plan, sharing organization, or government program mentioned. Health care sharing ministries and medical crowdfunding communities are not insurance and are not legally required to pay medical bills. Figures on this page are current for the 2026 tax year and were last reviewed on July 16, 2026; laws, limits, premiums, and third-party terms change frequently — verify current terms directly with the organization or agency involved. Archangel Michael Health does not sell insurance, and we receive no compensation, referral fee, or commission from any insurance company, health sharing organization, or platform mentioned on this page — we describe these options because patients ask about them, not because we’re paid to. Labs, imaging, and medications are billed separately from your membership; we’ll always tell you the price before you decide. Please consult a tax professional, a licensed insurance broker, and your own advisors for personalized recommendations.