About 80% of This Maine DPC Doctor's Patients Have No Insurance. The 2026 HSA Contribution Break Requires a Plan They Don't Have.

Practice Spotlight by DPC Insider — Practice Desk
#direct-primary-care#uninsured#hsa#new-hampshire#practice-economics
Sources: Direct primary care clinics offer a different way to pay, and to be cared for · Treasury, IRS provide guidance on new tax benefits for health savings account participants under the One, Big, Beautiful Bill · Publication 969, Health Savings Accounts and Other Tax-Favored Health Plans · Direct Primary Care · New England Direct Primary Care Alliance

Dr. Jack Forbush has run a direct primary care practice in Hampden, Maine for 14 years, back to when almost nobody was doing it. About 80% of his patients don’t have health insurance.

He told the Concord Monitor what those patients were doing before they found him. “These are people that either didn’t go see a doctor or went and had to pay an exorbitant amount of fee for fairly routine care, and therefore they wouldn’t go.”

Hold that number next to the DPC story the whole industry has been telling since January.

The clinic in Warner

The Monitor’s piece, published September 16, is mostly about Origins Direct Primary Care, a small clinic near the edge of downtown Warner, New Hampshire. Sarah Mullins, a family nurse practitioner, opened it two years ago after 12 years with Concord Hospital.

Membership runs $50 to $100 a month depending on age. That sits squarely inside the range the American Academy of Family Physicians reports for the model nationally, which is also $50 to $100. Prices vary by practice and by market, so treat both figures as a range rather than a rate card.

Kristy Ammann, 50, drives ten minutes from Hopkinton. She put her family of four’s annual insurance cost at close to $10,000. At Origins, each person pays $1,200 for the year.

Mullins says the arithmetic surprises people. “That’s something that most people aren’t aware of, that it is affordable,” she told the Monitor. “It is reachable, it is attainable even without insurance.”

What the HSA rule actually requires

Since January 1, 2026, fees for certain DPC arrangements have been HSA-eligible. Read the IRS announcement closely, because the qualifier does all the work: “an otherwise eligible individual enrolled in certain direct primary care (DPC) service arrangements may contribute to an HSA.”

Otherwise eligible individual is a defined term. Publication 969 spells out the test. Coverage under a high deductible health plan on the first day of the month is required. So is the absence of other disqualifying coverage. Medicare enrollment disqualifies you, and so does being claimed as someone else’s dependent.

Three of those four conditions run through an insurance product, and the fourth is a filing status. A patient with no coverage can’t fund an HSA this year and can’t claim the deduction.

The spending side works differently, and it’s worth being precise about it. Publication 969 puts the eligibility test under the heading for qualifying to contribute, and it doesn’t impose a current-coverage condition on distributions. So someone who carried an HDHP in the past and still holds a funded account can spend that balance on DPC fees. Someone who never had the plan has nothing sitting there to spend.

The change that DPC spent a year celebrating removed a penalty for people who already held an HDHP. For a patient with no plan and no prior balance, nothing moved.

The provision did precisely what it was drafted to do. But it leaves the policy conversation and the waiting room pointed at different people, and the gap is wider than most of the coverage suggests.

What serves the uninsured instead

The mechanism that actually lowers the bill for an uninsured patient in Warner is unglamorous and entirely manual. Mullins told the Monitor she has developed knowledge and relationships with imaging facilities and independent labs to get the best deals for her patients, and that she compares those rates against what insurance offers. Insurance rates, she says, tend to be much higher.

No Treasury notice did that. One provider did it, one vendor at a time, and she has to keep doing it.

Forbush built something adjacent. He co-founded the New England Direct Primary Care Alliance, a regional network of clinics, partly to recover the collegiality that hospital employment used to supply. The Alliance describes itself as a place for education, collaboration and sharing best practices among member clinics. It’s slow infrastructure, built by practices, for practices.

Jill Bowyer, another Origins patient, was somewhat skeptical about the price point at first. The 53-year-old from New London wondered whether a family that stays healthy would get anything for the money, and whether her clinician would really pick up. “It’s just been great,” she said. “I’ll have these weird hour-of-the-day problems, and I can just call her anytime, and she’ll pick up.”

The Tension the Model Lives Inside

The monthly fee is what makes DPC reachable for someone with no insurance. It’s also a bill that arrives whether or not a healthy family uses it, which is exactly what made Bowyer hesitate, and it’s the reason a $100 tier can be both a bargain and an obstacle for the same household.

Federal policy keeps building DPC supports on top of insurance products, because that’s the machinery Congress has. At least one practice’s panel is mostly people with no insurance product to build on. Forbush puts his own share at about 80%, and nothing in the sources behind this piece gives a figure for the model nationally.

No clinic can resolve that from the inside. It’s the ground the model is standing on.