Chart: Direct Primary Care Under Senators Cassidy, Cruz and Rubio bills

Treatment of Direct Primary Care (DPC) by Senators Cassidy, Cruz and Rubio Bills as it relates to Health Savings Accounts (HSA)

Specific Provision of the Bill

S. 2999 the Cassidy Enhanced Primary Care ActS. 3546 the Cruz Pandemic Health Care Access Act (Decoupling)

S. 12 the Rubio Health Savings Act of 2019

DPC allowed below HSA deductible







DPC is a qualified medical expense







DPC “premiums” can be paid out of HSAs tax-free 





[i] As defined in the recent IRS proposed rule expanding Qualified Medical Expenses to include payments for DPC and health care sharing ministries, Executive Order 13877, which directed the Treasury Secretary, to “propose regulations to treat expenses related to certain types of arrangements, potentially including direct primary care arrangements and healthcare sharing ministries, as eligible medical expenses under Section 213(d)” the proposed rule was published in the Federal Register in June 2020.

[ii] Since the IRS defines DPC as insurance, HSA funds may not be used tax-free to make monthly/annual fees for DPC because HSA funds may not be used tax-free to pay for insurance unless the individual is receiving unemployment benefits or paying COBRA or Medicare premiums.  The problem with DPC isn’t that the services are NOT 213 d qualified medical expenses.  The problem is that under the definitions of what makes an individual eligible to fund an HSA in IRC 223 c, DPC is recognized as a form of other coverage that would make an individual INELIGIBLE to fund an HSA.  This is the problem that Rubio and Cassidy fix.


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