Why
A 2025 law made these fees qualified medical expenses starting with months after December 31, 2025. Under IRS Notice 2026-5, the arrangement has to consist solely of primary care from primary care practitioners, and the sole payment for that care has to be a fixed periodic fee.
The care can't include procedures that require general anesthesia, prescription drugs other than vaccines, or lab services not typically done in a primary care setting.
Two rules are easy to mix up. To stay eligible to contribute to an HSA in 2026, total fees can't exceed $150 a month for one person or $300 for more than one, and they can be billed less often, such as $1,800 a year for one person. Those limits adjust for inflation after 2026. For reimbursement, the notice says there's no specific limit on the amount of the fee.
What to keep
- The membership agreement showing what's included and the fixed fee.
- Invoices showing the period covered and what you paid.
Watch out for
- A practice that bills members separately for the care in the arrangement, through insurance or otherwise, doesn't qualify. Some concierge practices do that.
- Fees your employer paid, including through pre-tax salary reduction, can't be reimbursed.
If you plan to reimburse yourself later
IRS Notice 2004-50, Q&A 39, sets no deadline, as long as the expense came after your HSA was established and your records show it wasn't paid by another source or deducted on a tax return. See what records the IRS expects and how long to keep them.