Can I use my HSA to pay for Fishtown Medicine membership?

Yes, you can use your HSA to pay for Fishtown Medicine membership. The 2025 Primary Care Enhancement Act formally classified DPC membership fees as qualified medical expenses, which makes the full membership eligible for HSA and FSA dollars.

Can I use my FSA the same way as my HSA?

Yes, you can use your FSA the same way for membership and qualified medical expenses. The main difference is that FSA funds typically expire at year-end (with limited rollover) while HSA funds roll forward indefinitely. Plan timing accordingly.

Do I need to keep receipts for HSA reimbursement?

Yes, you need to keep receipts for HSA reimbursement. Save the monthly invoice or annual receipt from Fishtown Medicine. We can also generate an end-of-year statement summarizing all eligible expenses for your records.

What about labs and imaging? Are they HSA-eligible?

Labs and imaging are HSA-eligible when ordered as part of your medical care. ApoB, fasting insulin, DEXA scans, hormone panels, and Coronary Artery Calcium scans all qualify. Save the receipts in case your HSA administrator asks for documentation.

Can my spouse or kids use my HSA for their care here?

Yes, your spouse and dependents can use your HSA for their qualified medical expenses, including their Fishtown Medicine membership. They do not need to be on your insurance plan to be HSA-eligible dependents.

Is the membership tax-deductible if I do not have an HSA?

The membership may be deductible if you itemize medical expenses on Schedule A and your total medical costs exceed 7.5 percent of adjusted gross income. Most people get a bigger benefit from an HSA. Talk to your tax advisor for your specific situation.

Will my HSA card actually work for the monthly fee?

Yes, your HSA card should work for the monthly fee. Most HSA debit cards run on standard payment networks and process Fishtown Medicine charges without issue. If your card declines, your administrator may need to enable DPC under the new IRS guidance.

What happens if I leave the practice mid-year?

If you leave the practice mid-year, prior payments remain qualified expenses. Your HSA does not get clawed back. You can put any remaining HSA balance toward future qualified medical care, including a new physician.

How does an HSA actually save me money?

An HSA saves you money in three ways. Contributions reduce your taxable income today. Earnings grow tax-free. Withdrawals for qualified medical expenses (now including DPC) come out tax-free. Together, that is roughly a 25 to 35 percent effective discount, depending on your bracket.

Can my employer contribute to my HSA?

Yes, your employer can contribute to your HSA, and many do as part of benefits packages. Employer contributions are not taxed and count toward the annual contribution limit. Some Philly employers (especially in tech and consulting) match a portion of HSA contributions.

How is an HSA different from an HRA or FSA?

An HSA belongs to you, rolls over forever, and stays with you when you change jobs. A Health Reimbursement Arrangement (HRA) is funded by your employer and tied to your job. An FSA is employee-funded but typically use-it-or-lose-it within a plan year.

What is the contribution limit for 2026?

The HSA contribution limit for 2026 is set annually by the IRS and continues to rise with inflation. Self-only and family limits differ, and a catch-up contribution applies once you turn 55. Check the IRS table for the year-specific number.

Are GLP-1 medications HSA-eligible?

Yes, GLP-1 medications are HSA-eligible when prescribed for a documented medical condition (type 2 diabetes, obesity, or related metabolic disease). We provide the prescription and documentation as part of your care plan.

Can I use my HSA for hormone replacement therapy?

Yes, you can use your HSA for hormone replacement therapy that is medically prescribed. We document the diagnosis and indication in your chart so your HSA administrator can verify eligibility if needed.

How does this interact with high-deductible health plans?

HSA eligibility requires that you are enrolled in a qualifying high-deductible health plan (HDHP). The Primary Care Enhancement Act clarified that DPC arrangements do not disqualify you from contributing. Confirm your HDHP status during enrollment.

Can I pay for membership for a parent or other dependent?

You can pay for a parent or dependent's care with HSA dollars only if they qualify as your dependent under IRS rules (generally, you provide more than half their support). Otherwise, they need their own HSA or to pay out of pocket.

What if I am self-employed in Philadelphia?

If you are self-employed, you can open and fund an HSA as long as you have an HDHP. Self-employed members get an above-the-line deduction for HSA contributions, which is one of the largest tax advantages available. Many Fishtown freelancers and creatives use this stack to pay for our care.

How do Letters of Medical Necessity work?

A Letter of Medical Necessity is a short physician-written document stating that a specific item (for example, a continuous glucose monitor or gym membership) is medically necessary for treating a diagnosed condition. We provide LMNs for items already integrated into your treatment plan, then you submit them with receipts to your HSA or FSA administrator.

What expenses are still NOT HSA-eligible at Fishtown Medicine?

Items considered purely cosmetic, lifestyle without a medical indication, or aspirational wellness without a documented diagnosis remain ineligible. Examples include certain spa treatments or unprescribed home gadgets. We help you understand the line between eligible care and out-of-pocket extras.

How do I document HSA expenses if I get audited?

For an audit, keep monthly receipts, your end-of-year membership summary, lab and imaging invoices, and any LMNs we provided. Most members keep these in a single cloud folder. Documentation is rarely requested, but it pays to be ready.

TL;DR · 30-second take

Yes, you can use your HSA or FSA to pay for Direct Primary Care at Fishtown Medicine. The 2025 Primary Care Enhancement Act recognizes DPC membership as a qualified medical expense, so monthly fees, advanced labs, and prescribed wellness tools are eligible for pre-tax dollars.

The Pre-Tax Hack for Premium Care (2026 Update: roughly 30% effective discount on membership)

Q: What changed with the Primary Care Enhancement Act in 2025?

The Primary Care Enhancement Act amended the tax code to formally treat Direct Primary Care arrangements as compatible with HSA contributions and to classify membership fees as qualified medical expenses under Section 213(d). It removed the older interpretation that treated DPC as "another health plan," which previously disqualified some patients from contributing to an HSA.

The gray area is gone. The era of pre-tax primary care is here.

For years, the IRS treated Direct Primary Care (DPC) membership fees as a gray area. Patients had to ask for itemized superbills, jump through hoops, and were sometimes denied reimbursement. That ended in 2025. With the passage of the Primary Care Enhancement Act, the federal government officially recognized what we have known all along: preventive, relationship-based primary care is medical care. The legislation explicitly defines DPC membership fees as "qualified medical expenses" under Section 213(d) of the tax code.

What does this mean for your HSA or FSA?

If you have a Health Savings Account (HSA) or Flexible Spending Account (FSA), your Fishtown Medicine membership is now 100 percent eligible without superbills, caveats, or complex accounting. This is effectively a 25 to 35 percent discount on your healthcare, depending on your tax bracket. By using pre-tax dollars (which would otherwise be taxed at your highest marginal rate), you are paying for premium, concierge-level care with money the government never touched.

How does the new pre-tax stack work?

The new pre-tax stack works in three layers. Here is how our savviest members structure their health investment in 2026.

1. The Membership (100 percent eligible)

You can set up your HSA or FSA card as the primary payment method for your monthly or annual membership.

Action: Log in to the member portal and swap your credit card for your HSA card. Done.

2. The Deep Diagnostics (100 percent eligible)

Advanced testing is fully covered when ordered as part of your medical care.

ApoB and Advanced Lipids: Covered.
Fasting Insulin and CGM: Covered.
DEXA Scans: Covered.
Hormone Panels: Covered.
Coronary Calcium and Cleerly Scans: Covered.

3. The Wellness Items (Letter of Medical Necessity)

While the membership is automatically covered, certain wellness items still need a documented diagnosis to be eligible. We handle this with a Letter of Medical Necessity (LMN) during your annual physical.

Gym Memberships: Eligible when prescribed for hypertension, obesity, or insulin resistance.
Oura Ring or Whoop: Eligible when prescribed for sleep apnea or stress management.
Supplements: Eligible when targeting a documented deficiency (for example, vitamin D for confirmed deficiency).

Guidance from the Clinic

"This legislation is a real win for patients. It acknowledges that access to a doctor is just as medically necessary as a pill or a procedure. By removing the tax penalty, the government has effectively subsidized your ability to have a physician on call. Use this benefit."

Actionable Steps in Philly

Stop letting your HSA sit there earning 0.1 percent interest. Deploy it.

Switch Your Payment: Go to your Fishtown Medicine portal today and add your HSA card.
Max Out the Contribution: For 2026, the HSA contribution limit increased again. Max it out to lower your taxable income.
Download Your LMN: We provide a Letter of Medical Necessity for prescribed gym memberships and supplements by default. We believe in proactive prevention and provide the documentation to help you pay for it pre-tax.
Pair With an HDHP: An HSA only stays open with an eligible high-deductible health plan. Confirm your insurance is HSA-compatible during open enrollment.
Keep Receipts in One Folder: Save digital receipts for membership, labs, and supplements in a single cloud folder so reimbursement (or audit) is painless.

Scientific References

Internal Revenue Service. Publication 502: Medical and Dental Expenses. (Updated annually.)
Internal Revenue Service. Publication 969: Health Savings Accounts and Other Tax-Favored Health Plans. (Updated annually.)
American Academy of Family Physicians. Direct Primary Care: A New Way to Pay for Health Care. Fam Pract Manag. 2018;25(1):16-20.

Medical Disclaimer: This resource provides clinical and tax context for educational purposes. It is not legal, financial, or tax advice. Consult a qualified tax professional for your specific situation, and consult Dr. Ash to determine which clinical interventions are right for you.

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TL;DR · 30-second take

The Pre-Tax Hack for Premium Care (2026 Update: roughly 30% effective discount on membership)

The gray area is gone. The era of pre-tax primary care is here.

What does this mean for your HSA or FSA?