A DPC Fee Can Cover a Whole Year Under Notice 2026-5. The Word That Limits It Is "Solely."

A direct primary care fee can cover a full year at a time. You might have assumed the $150 monthly cap forced monthly billing, and the guidance says otherwise in as many words.

IRS Notice 2026-5 answers it at A-13. A direct primary care service arrangement “may include an arrangement that has fees that are billed for periods of more than a month, but no more than a year provided the aggregate fees are fixed, periodic, and do not exceed the monthly limit (on an annualized basis).” The notice then works the arithmetic itself: “For 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.”

For a practice that would rather invoice once a year than twelve times, that is the whole ballgame.

Then it gets strict.

”Solely” is doing the work

The statutory definition is one sentence and every clause of it bites. A direct primary care service arrangement means an arrangement under which an individual “is provided medical care (as defined in section 213(d)) consisting solely of primary care services provided by primary care practitioners …, if the sole compensation for such care is a fixed periodic fee.”

Medical care. Solely primary care services. Primary care practitioners. A fixed periodic fee as the sole compensation. Miss one of those and the arrangement isn’t a DPCSA, however carefully the rest is built.

The monthly limit sits outside that list, and the difference is worth money. A-20 confines the limit to section 223(c)(1)(E), the test for whether an arrangement counts as disqualifying coverage. An arrangement priced above $150 for an individual is still a DPCSA, and its fees are still reimbursable from an HSA. What the member loses is the ability to contribute, not the ability to pay the fee with HSA dollars.

A-11 handles the billing half. “No, the sole compensation for care provided under a DPCSA must be the fixed periodic fee. Thus, a DPCSA under section 223(c)(1)(E) does not include an arrangement that provides certain healthcare items and services to individuals on the condition that they are members in the arrangement and have paid a fixed periodic fee, but bills separately for those items and services (through insurance or otherwise).”

Two moving parts there. Care has to be provided under the arrangement, and that same care has to be billed separately. Both have to hold for the clause to bite.

A-12 is the narrow allowance beside it. Where an arrangement otherwise qualifies as a DPCSA, services offered outside of the arrangement may be billed separately, through insurance or otherwise, to members and non-members. The phrase carrying the weight is “outside of the arrangement.”

The member can’t fix the terms

Which raises the obvious workaround. If a membership bundles things beyond primary care, can a member decline those and keep DPCSA treatment for the rest?

A-14 answers no, in one sentence. “Whether an arrangement qualifies as a DPCSA under section 223(c)(1)(E) depends on the terms of the arrangement, not the services used by an individual.” Terms that provide non-primary-care services put the arrangement outside the definition, and no amount of member-level abstinence repairs it.

Scope is a drafting problem, not a usage problem.

A tier ladder that shows the shape

MDRI, Medical Doctors of Rhode Island, lists practices and providers in Johnston, East Greenwich and Lincoln, and offers three membership options. Standard is the no-cost one: continued access to your provider for annual visits, follow-ups and urgent care, with scheduling based on availability. Enhanced adds a nurse clinical liaison, coordination of non-covered testing, and preferred pricing. Concierge adds private, secure communication with your physician for non-urgent medical questions, guidance and follow-up, available seven days a week, plus increased discounts on supplements and regenerative medicine services. There’s no single rate card to quote, because the page says plainly that “Membership pricing and available tiers vary by provider.”

The page is also direct about what the fee is. “Membership fees are for non-covered administrative and wellness services and are not reimbursable by insurance.” It goes on to say insurance-covered medical services keep getting billed to your insurance plan in accordance with your benefits, and that non-members keep access to medically necessary covered services under their insurance.

MDRI doesn’t present any of this as a direct primary care service arrangement, and the ladder is worth reading for how hard it makes the classification. The page’s own characterization is that the fee buys non-covered administrative and wellness services rather than medical treatment, with covered care billed to insurance and available to non-members too. That is nearer the regardless-of-membership shape A-12 contemplates than the conditioned-and-separately-billed pattern A-11 forbids.

The same page also sells physician communication for non-urgent medical questions and a nurse liaison who answers general health questions. Whether those are section 213(d) medical care paid for by the fee isn’t settled by what the practice calls them, and from outside the agreement there’s no way to tell.

A-14 is what bites once an arrangement does provide care under the fee and writes supplements, testing or wellness into the same terms. That is the version a member cannot repair by abstaining.

The Counterargument

The strongest objection is that bundling is the point. Wholesale labs, dispensing at cost, a nurse who answers the phone: patients value those, and a membership that is only access feels thin beside one that includes things. Telling a physician to strip them out reads like letting a tax definition design the practice.

That objection is right about the instinct and wrong about the remedy. Nothing here stops a practice from selling any of it. What the definition stops is folding those services into the terms of the arrangement whose fee a patient wants to pay with HSA money, and A-12 points at the alternative in the same breath: offer them outside the arrangement, billed separately, to members and non-members alike.

So the structure holds up. Write the arrangement narrow, keep the extras beside it, and A-13’s cadence freedom is yours. The practices that struggle will be the ones that drafted one document to do both jobs.