Direct Primary Care, Insurance and Your HSA

Do I still need insurance?

Yes, for most people. A direct primary care membership is not health insurance. It covers your primary care visits and direct access to your physician, but not hospital stays, emergency care, surgery, specialist visits, advanced imaging or most prescriptions. Most members keep an insurance plan for those, and many pair Ridgeview with a lower-premium, higher-deductible plan. Our article on whether direct primary care replaces insurance goes into more detail.

Direct primary care with a high-deductible plan

With a high-deductible plan, routine primary care often comes out of pocket until the deductible is met. A flat membership turns that into a predictable monthly cost with unlimited primary care visits, while your insurance stays in place for the large, unpredictable expenses. See direct primary care with a high-deductible health plan.

Using your HSA

Starting in 2026, federal law allows a qualifying direct primary care arrangement alongside an HSA. If an arrangement qualifies, being a member does not stop you from contributing to your HSA, and the membership fee can be paid with HSA funds. For 2026, the fee must be no more than $150 a month for one person or $300 a month for an arrangement covering more than one person.

IRS guidance adds conditions. The fixed periodic fee must be the only payment for the care the arrangement covers, and some details, such as how separately priced services and one-time fees are treated, are still being clarified. A household membership that adds several children can also go above the $300 limit. Before using HSA funds or making contributions, ask the office and your HSA administrator whether your membership qualifies.

Your HSA administrator decides how reimbursement works for your account, and this page is general information, not tax advice. Our guide, Can you use an HSA or FSA to pay for direct primary care?, explains the rules and the questions to ask.

FSA and HRA accounts

Flexible spending accounts and health reimbursement arrangements are set up by employers, and each plan decides which expenses it reimburses. Some reimburse direct primary care fees and some do not. Ask your plan administrator, and the office can provide receipts for your membership payments.

Healthshare members

Healthshare programs are not insurance, but many members of healthshares choose direct primary care for their everyday care. Each program sets its own rules about whether it shares membership fees or visit costs, so check your program guidelines.

Sports medicine invoices

Sports medicine visits, ultrasound and injections are billed separately from membership and are available to members and non-members at published prices. Ridgeview does not bill insurance directly for these services. On request, the office can provide an itemized invoice with diagnosis and procedure codes that you can submit to your insurance as an out-of-network claim. Whether your plan reimburses any of it depends on your plan. See sports medicine pricing.

Labs, imaging and prescriptions

When you need labs, imaging or a specialist, Dr. Kroner orders them and helps you find a sensible option, whether that is through your insurance or a cash price. You will know about costs before tests are ordered.