To amend the Internal Revenue Code of 1986 to allow individuals with direct primary care service arrangements to remain eligible individuals for purposes of health savings accounts, and for other purposes.
Analysis under review: This bill has generated analysis that may be too generic or incomplete. Clause-level evidence remains available below.
Summary
What This Bill Does
The bill amends IRC Section 223 to exempt Direct Primary Care (DPC) service arrangements from being treated as health plans, allowing HSA holders to pay up to $150/month ($300 for family coverage) for DPC memberships while. It relies on exemptions, definition changes, and reporting requirements. The main policy areas are Healthcare and Finance.
Who Benefits and How
Direct Primary Care (DPC) clinics and physicians offering subscription-based primary care could gain revenue opportunities, Individuals with Health Savings Accounts (HSAs) who want to use DPC services could see lower costs, and Health insurance companies selling high-deductible health plans (HDHPs) paired with HSAs could gain revenue opportunities.
Who Bears the Burden and How
IRS and Treasury Department would take on compliance duties and Employers offering DPC arrangements as a benefit would take on compliance duties.
Key Provisions
- Amends IRC Section 223 to exempt Direct Primary Care (DPC) service arrangements from being treated as health plans, allowing HSA holders to pay up to $150/month ($300 for family coverage) for DPC memberships while...
Evidence Chain:
This summary is generated from the full bill text using AI analysis. Expand "Detailed Analysis" below for identified beneficiaries/burden bearers with clause-level evidence links.
At a Glance
What This Bill Does
The bill amends IRC Section 223 to exempt Direct Primary Care (DPC) service arrangements from being treated as health plans, allowing HSA holders to pay up to $150/month ($300 for family coverage) for DPC memberships while.
Key Policy Areas
Healthcare, Finance
Primary Purpose
The bill amends IRC Section 223 to exempt Direct Primary Care (DPC) service arrangements from being treated as health plans, allowing HSA holders to pay up to $150/month ($300 for family coverage) for DPC memberships while.
Policy Domains
HR 1026 - Primary Care Enhancement Act of 2025
Identified Gains
- Direct Primary Care (DPC) clinics and physicians offering subscription-based primary care
- Individuals with Health Savings Accounts (HSAs) who want to use DPC services
- Health insurance companies selling high-deductible health plans (HDHPs) paired with HSAs
Identified Costs
- IRS and Treasury Department
- Employers offering DPC arrangements as a benefit
Sponsors
Legislative Progress
IntroducedMr. Smucker (for himself, Ms. Tenney, Mr. Schneider, Mr. Panetta, …
Stakeholder Effects
cui bono?How this legislation distributes effects. Mention counts reflect frequency, not effect magnitude.
Direct Primary Care (DPC) clinics and physicians offering subscription-based primary care
Individuals with Health Savings Accounts (HSAs) who want to use DPC services
Health insurance companies selling high-deductible health plans (HDHPs) paired with HSAs
Bill Structure & Actor Mappings
Who is "The Secretary" in each section?
- "the_secretary"
- → Secretary of the Treasury
- "secretary_of_hhs"
- → Secretary of Health and Human Services
Note: The Secretary (of the Treasury) is the primary actor, with consultation required from the Secretary of Health and Human Services for regulatory guidance on primary care services exclusions.
Key Definitions
Terms defined in this bill
Medical care that does NOT include: (I) procedures requiring general anesthesia, (II) prescription drugs (other than vaccines), and (III) laboratory services not typically administered in an ambulatory primary care setting.
An arrangement under which an individual is provided medical care (as defined in section 213(d)) consisting solely of primary care services provided by primary care practitioners (as defined in section 1833(x)(2)(A) of the Social Security Act), if the sole compensation for such care is a fixed periodic fee.
For any individual for any month, an arrangement is not a direct primary care service arrangement if the aggregate fees for all DPC arrangements exceed $150 per month ($300 for arrangements covering more than one individual).
Defined in section 1833(x)(2)(A) of the Social Security Act (referenced but not reproduced in this bill)
We use a combination of our own taxonomy and classification in addition to large language models to assess meaning and potential beneficiaries. High confidence means strong textual evidence. Always verify with the original bill text.
Learn more about our methodology