A New Virginia DPC Practice Prices Memberships by Age, From $139 to $299 a Month. Only the Youngest Monthly Tier Stays Under the Federal HSA Cap.

Most DPC practices publish one price. New Kent Direct Care published four, sorted by age, and in doing so it walked straight into the one number Congress wrote into the model, which took effect in January.

The practice opens this month at 3215 Rock Creek Villa Drive in Quinton, in New Kent County east of Richmond. Richmond BizSense reported the launch on September 29. Six owners, three married couples, all with local ties: Christopher and Angie Lindsay, Sean and Jaynie Lindsay, Payton Hardinge and Matt Nottingham. The same report says New Kent County grew nearly 22 percent between 2020 and 2025, to roughly 28,000 residents, and that the county’s existing primary care practice stopped taking new patients more than a year ago. That is a clean reason for six people to open a clinic in the county they live in.

The membership page lists the tiers plainly for members under 65. $139 a month for ages 18 to 30. $179 for 31 to 49. $239 for 50 to 64. For 65 and older the page publishes no rate, routing that band to a one-to-one call because the options “look a little different”; the $299 figure comes from the founders’ interview with Richmond BizSense. A one-time, non-refundable $150 enrollment fee applies to every new member, and anyone joining by September 30 locks in 15 percent off the rate. Every tier buys identical access, and the practice sees patients 13 and up, with teens added to a family membership. Membership pricing varies by practice and by market, and these are this practice’s own published figures rather than a regional average.

For scale, the AAFP puts typical DPC monthly fees at $50 to $100, against an average panel of 413 patients. Every tier here sits above that range. The top tier sits at triple it.

The cap does not care how old you are

Section 71308 of the One Big Beautiful Bill Act let patients keep contributing to a health savings account while enrolled in a direct primary care arrangement, starting in 2026. It came with a ceiling. IRS Notice 2026-5 states that the term does not include any arrangement “if, with respect to an individual for a month, the aggregate fees for all DPCSAs for the individual for a month exceed $150 (or $300 for any such arrangement that covers more than one individual).” The limit is adjusted for inflation for tax years after 2026.

One flat number, with no age bands in it.

On New Kent’s monthly plans, the 18 to 30 tier sits $11 under the cap. The other three sit above it. The founding discount does not rescue the second tier either, because 15 percent off $179 is $152.15.

What a patient over the line loses is narrower than it sounds, and the notice is specific about it. A-20 says fees that miss the monthly limit “will be treated as medical expenses reimbursable from an HSA in accordance with section 223(d)(2)(C)(v) but will disqualify the covered individual from eligibility for making HSA contributions while the individual is enrolled.” The membership stays payable with HSA dollars. What goes is the right to put new money into the account.

New Kent’s page gets that first half right. It tells prospective members their membership “may be HSA eligible” and that as of 2026 “direct primary care memberships qualify for reimbursement through a health savings accounts.” Accurate. The page says nothing about the contribution side, which is the half that costs the patient something.

The 65 and older tier is a special case. Anyone enrolled in Medicare already has a contribution limit of zero, per IRS Publication 969: “Beginning with the first month you are enrolled in Medicare, your contribution limit is zero.” For most of that tier the $150 cap changes nothing, because Medicare got there first.

Pay annually and the same patient lands on the other side

The notice also addresses fees billed for longer periods. A-13 permits them “provided the aggregate fees are fixed, periodic, and do not exceed the monthly limit (on an annualized basis),” then gives a worked example for 2026: “the fee for a single individual could be $1,800 for a year; $900 for six months; or $450 for three months.”

New Kent’s annual rate for ages 31 to 49 is $1,790. That is $10 under the IRS’s own annual figure. The semi-annual rate for the same band is $895, five dollars under the notice’s six-month example.

Same patient, same practice, same care. The monthly plan at $179 puts them past the line, and the annual plan at $1,790 does not. A 42-year-old paying month to month gives up HSA contributions. If they pay the year up front, they keep them.

Nothing on the practice’s page mentions this, and there is no reason to think it was designed that way. The annual tiers carry two free months, which is ordinary DPC retention pricing. The tax consequence is a side effect of the discount.

The 50 to 64 band gets no such escape. $2,390 a year is $590 past the annualized limit no matter how it is billed.

Two lines the price sheet does not settle

The practice bills separately for testing beyond what a wellness visit covers, quoting the cost before anything is ordered. The notice draws a line near there. A-11 says the sole compensation for care under a qualifying arrangement must be the fixed periodic fee, while A-12 permits providers in an otherwise qualifying arrangement to offer items and services outside it and to bill members and non-members alike for those. The public page does not say which side of that line its lab billing sits on.

The $150 enrollment fee raises a second question the guidance leaves open. Notice 2026-5 never uses the phrase “enrollment fee” and never addresses a one-time charge at all. The statute speaks only of a fixed periodic fee.

The tension the model lives inside

Age-rated DPC pricing is defensible on its own terms. A 68-year-old with four chronic conditions takes more of a practice’s week than a 26-year-old does, and a practice holding panels small enough to answer its own phone has to price for that. New Kent charges more where the work is heavier. That is honest pricing, not a markup.

Congress wrote a flat cap. Patients get older, use more primary care, pay more for it, and cross a line that does not move with them. The tax break Congress built for direct primary care reaches furthest for the patients who need primary care least.

No practice fixes that from a pricing page. New Kent can hold the 31 to 49 band at $179 and watch its monthly payers lose contribution eligibility, or price the band at $150 and absorb $29 per member per month, or steer members toward annual billing for a tax reason it did not design. Three options, all of them compromises. The cap is indexed for inflation after 2026, so the number will move. It will not learn to age.