Direct Primary Care, HSAs, and the Shift Providers Need to Prepare For

By: Lidice F. Porro, Esq.

Direct Primary Care has been inching toward broader federal recognition for years. What has changed recently is not a single sweeping law, but momentum. Lawmakers, regulators, and professional associations are increasingly aligned around one idea: DPC should be treated differently from insurance and should eventually integrate more cleanly with Health Savings Accounts.

That shift creates opportunity. It also creates risk for practices that assume their current structure and contracts will automatically qualify.

If you operate a DPC or membership-based medical practice in Florida, here is what you should understand heading into 2026.

1. The Federal HSA Issue Is Evolving, Not Settled

Several federal proposals, including versions of the Primary Care Enhancement Act, would allow patients to use HSA funds to pay for DPC memberships without jeopardizing their ability to contribute to an HSA.

These proposals commonly reference monthly fee caps of $150 for individuals and $300 for families. Important clarification: these caps are not currently binding IRS rules. They are part of proposed legislation that reflects where federal policy is heading.

Why this matters now: practices that significantly exceed these thresholds may find themselves needing to restructure pricing later, under time pressure, if federal guidance is finalized. Sophisticated practices are already auditing their fee models with this in mind.

2. Florida’s DPC Safe Harbor Is Very Real

While federal HSA treatment remains in flux, Florida’s regulatory framework is not.

Under Florida Statute § 624.27, DPC agreements must be structured carefully to avoid being classified as unlicensed insurance. In practice, this means your contracts should include:

• A clear, prominent disclosure that the agreement is not health insurance

• Termination rights that allow either party to exit the agreement, commonly with 30 days’ written notice

• Language that reinforces the limited scope of services covered by the membership

These are not “formality” issues. They are the first things regulators and opposing counsel look at if a dispute arises.

3. Service Creep Is a Compliance Risk

As DPC practices grow, many expand offerings. The problem is that membership models that bundle specialty procedures, anesthesia-based services, or non-primary-care treatments start to drift away from what both federal proposals and state regulators consider “primary care.”

This does not mean expansion is prohibited. It means your contracts, pricing, and disclosures must clearly distinguish between membership-covered primary care services and services that fall outside the DPC model and are billed separately.

When this line blurs, practices move out of the DPC safe harbor and into concierge or hybrid territory, with very different regulatory implications.

4. Entity Structure Still Matters

I regularly see Florida providers operating through standard LLCs without revisiting whether that structure aligns with professional licensure requirements.

Under Florida law, licensed professionals are often expected to operate through a professional entity, such as a PLLC, particularly when clinical services are involved. As new entity structures and Series LLC legislation continue to emerge, having your base entity correctly formed and maintained is foundational, not optional.

Entity mistakes do not usually cause problems immediately. They surface during disputes, audits, or transactions, when fixing them is most expensive.

Preparing, Not Reacting

The direction of travel is clear. DPC models are gaining legitimacy, but with legitimacy comes scrutiny. Practices that wait for finalized IRS rules or enforcement actions will be reacting. Practices that audit now will be positioned to adapt smoothly.

I work with Florida providers to review DPC agreements, fee structures, and entity formation with an eye toward both current compliance and where the law is heading.

If you are unsure whether your practice is structured to stay within Florida’s safe harbor and remain flexible for future HSA integration, that is a strategy conversation worth having.

www.lfporrolaw.com/strategy