DPC and HSAs: The $150 Rule and How to Opt Out of Medicare | Dr. Phil Eskew

Direct Primary Care no longer disqualifies patients from HSA eligibility. As of January 1, 2026, DPC membership fees are a qualified HSA expense at or below $150 per month for one person and $300 for a family. Above $150 you are not in violation. You are in the same gray zone DPC lived in for a decade, and the tax position belongs to the patient and their accountant, not to you.Dr. Phil Eskew (DO, JD, MBA) of DPC Frontier joins Dr. Maryal Concepcion to break down what changed and what it means for your practice, then walks through the Medicare opt-out calendar most physicians discover too late.KEY NUMBERS AND DATES $150/month per person, $300 family. Effective January 1, 2026. Opt-outs take effect only on January 1, April 1, July 1, October 1. Affidavit must be filed at least 30 days before the effective date. File by roughly December 1, 2026 to be opted out January 1, 2027. 90-day reversal window, but you must refund every membership dollar collected.QUESTIONS ANSWEREDCan patients use an HSA to pay for direct primary care? Yes, as of January 2026. Both old IRS objections were fixed: whether the fee is a medical expense, and whether membership disqualifies HSA contributions.Should I put "HSA eligible" on my website? No. Write "We accept HSA cards." Promising eligibility in your marketing or agreement takes on a tax position on your patient's behalf.How do I get under $150 without losing revenue? Enrollment fees are not compensation for care. Blood draws, injections, EKGs, and dispensed medications can price separately.What does the rule exclude? Prescription drugs other than vaccines, and lab services not typically done in an ambulatory primary care setting.If I opt out, can I still order labs and referrals? Yes. Opting out is not disenrollment. You stay credentialed and Medicare pays for labs, imaging, referrals, DME, and prescriptions you order.Where can I still work while opted out? VA, Indian Health Service, corrections, and hospice administrative work. Precepting usually requires participation. TRICARE requires Medicare participation. Medicaid uses ORP/OPR status, prohibited in Kentucky and Colorado.Does opt-out apply to Medicare Advantage? Yes. Opt-out applies to all Medicare programs nationwide. You cannot opt out selectively.MENTIONED DPC Frontier · McCarran-Ferguson Act (1945) · ACA primary care carve-out · bronze and catastrophic plans as HSA-compatible · capacity vs. competency · durable power of attorney · prior authorization escalation strategyHAVE A QUESTION? WE ANSWER THEM ON AIR. Leave a voicemail at mydpcstory.com/contact with your name, state, and question.NEXT EPISODE: ILLINOIS, timed to the Illinois DPC Summit, October 2 and 3, NIU Naperville. Subscribe to the My DPC Story newsletter at mydpcstory.com to know when it drops.Educational only. Not legal or tax advice. Dr. Eskew is not your attorney.Explore Hint's Marketplace today, an app-like experience connecting all your tools into Hint! CHIEF COMPLAINT COFFEE & TEA. Celebrating when nothing comes between you and your patient. NO PRIOR AUTHS. Literally, that's one of the coffees you'll find at CHIEF COMPLAINT COFFEE & TEA.Support the showGET your FREE MONTHLY BUSINESS TOOL DOWNLOADBecome A My DPC Story PATREON MEMBER! SPONSOR THE PODMy DPC Story VOICEMAIL! DPC SWAG!FACEBOOK * INSTAGRAM * LinkedIn * TWITTER * TIKTOK * YouTube