To amend the Internal Revenue Code of 1986 to allow individuals with direct medical care service arrangement to remain eligible individuals for purposes of health savings accounts, and for other purposes.
Sponsors
Legislative Progress
IntroducedMr. Roy (for himself, Mr. Biggs of Arizona, and Mr. …
Summary
What This Bill Does
This bill allows people who pay a monthly fee to a "direct primary care" (DPC) doctor to also contribute to a Health Savings Account (HSA). Currently, having a DPC arrangement can disqualify someone from using an HSA because the IRS may treat it as health coverage. This bill fixes that by explicitly stating DPC arrangements are not health plans for HSA purposes.
Who Benefits and How
Direct primary care physicians and practices benefit because this removes a major barrier to patient enrollment - many potential patients avoided DPC because they did not want to lose their HSA eligibility. Consumers who want both a subscription-style doctor relationship and tax-advantaged health savings can now have both. This particularly helps self-employed individuals and those with high-deductible health plans who value the predictable costs and easy access of DPC medicine.
Who Bears the Burden and How
Employers who offer DPC arrangements as a benefit must now report the total fees paid on employees' W-2 forms, creating a minor new paperwork requirement. Traditional health insurers may see slightly reduced market share as the DPC model becomes more attractive to consumers. The IRS faces a small administrative burden implementing the new rules.
Key Provisions
- Excludes direct medical care service arrangements from being treated as disqualifying health coverage for HSA eligibility
- Defines DPC arrangements as those providing medical care from physicians, nurse practitioners, or physician assistants for a fixed periodic fee
- Allows DPC arrangements to cover any subset of medical care (primary care only, specialty care, etc.)
- Requires employers to report aggregate DPC fees on employee W-2 forms
- Takes effect for months beginning after December 31, 2024
Evidence Chain:
This summary is derived from the structured analysis below. See "Detailed Analysis" for per-title beneficiaries/burden bearers with clause-level evidence links.
Primary Purpose
Allows individuals with direct medical care service arrangements (fixed-fee doctor subscriptions) to contribute to Health Savings Accounts without the DPC arrangement being treated as disqualifying health coverage
Policy Domains
Legislative Strategy
"Enable direct primary care (DPC) business model to coexist with HSAs by removing regulatory barrier that currently treats DPC as disqualifying health coverage"
Likely Beneficiaries
- Direct primary care (DPC) practices and physicians offering membership-based medical services
- Patients/consumers who want to use both DPC arrangements and HSAs simultaneously
- Healthcare alternatives to traditional insurance models
Likely Burden Bearers
- IRS (minor administrative burden to implement new tax code provisions)
- Employers offering DPC arrangements (new W-2 reporting requirement for aggregate fees)
Bill Structure & Actor Mappings
Who is "The Secretary" in each section?
- "the_secretary"
- → Secretary of the Treasury (implied by IRC amendments)
Key Definitions
Terms defined in this bill
An arrangement under which an individual is provided medical care by medical care practitioners where the sole compensation is a fixed periodic fee. Can be restricted to any subset of medical care or practitioners (e.g., primary care only).
Has the meaning given in IRC section 213(d) (generally: diagnosis, cure, mitigation, treatment, or prevention of disease)
A physician (as defined in Social Security Act section 1861(r)(1)), or a nurse practitioner, clinical nurse specialist, or physician assistant (as defined in Social Security Act section 1861(aa)(5)).
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