A DPC Doctor Left Insurance for a Health Share. HSAs Need an HDHP

Ben Hagopian took his own family off health insurance. He’s a board-certified family physician who runs a direct primary care practice in southern Maine, and in an essay Business Insider published on Oct. 25 he describes what replaced it: a DPC membership for routine care and a medical cost-sharing community “for the big stuff.”

He calls the switch “the best financial and medical decision I’ve ever made.” The essay makes a vivid case for the pairing. It also skips the rule that decides whether that household can keep using a health savings account, and 2026 is the year the rule started to matter for DPC.

What he describes

Hagopian writes that he left an insurance-based practice after years of 15-minute appointments. His patients now pay him a flat fee of “around $100 per month.” He says he went from seeing 20 patients a day to six or eight, and that patients can text him directly.

He also says he offers patients wholesale pricing on labs and imaging. A thyroid test that cost $300 at his old job, he writes, now costs $8 in his practice.

His fee sits at the top of the range the American Academy of Family Physicians reports. AAFP says DPC monthly fees “generally range from $50 to $100.”

The family math is the center of the essay. Under what he calls a “supposedly high-end” insurance plan, Hagopian says the family still owed about $10,000 after their first child’s birth, on top of premiums. For their second child they were in a cost-share program where the “Initial Unshareable Amount,” the part the family pays before other members share the bill, was $1,500. He says the community shared the rest.

What a health share is

Hagopian writes plainly that the cost-sharing community “isn’t insurance.” State regulators say the same of health care sharing ministries, and they spell out what follows.

North Carolina’s Department of Insurance tells consumers that people who join a health care sharing ministry “do not receive a guarantee that their health care bills will be paid.” Members instead agree to share costs “on a voluntary basis.” Michigan’s insurance regulator went further in 2024: the ministries “are not legally or contractually obligated to pay health care costs,” and they don’t have to cover pre-existing conditions or essential health benefits.

Federal law defines the term narrowly. Under 26 U.S.C. 5000A, a health care sharing ministry is a 501(c)(3) whose members “share a common set of ethical or religious beliefs,” and it must have shared members’ medical expenses continuously since at least Dec. 31, 1999. Hagopian’s essay doesn’t name his family’s program or say whether it meets that test.

None of that makes his choice wrong. A $1,500 amount before sharing begins is a real number, and he reports it held up for a birth. If his program works like the ministries regulators describe, though, the backstop for a large bill is an arrangement with no legal obligation to pay it.

The HSA rule the essay skips

IRS Notice 2026-5 explains how the One Big Beautiful Bill Act changed HSA rules for DPC. Before the change, the notice says, a person enrolled in a DPC arrangement “generally was not eligible to contribute to an HSA.” Now a qualifying direct primary care service arrangement is no longer treated as a health plan for that test.

That fix helps people who already have the right coverage. The notice states the starting condition: to contribute, an individual must “be covered under a high deductible health plan (HDHP) and have no disqualifying health coverage.” The statute defines an eligible individual as someone “covered under a high deductible health plan as of the 1st day of such month.”

Neither the statute nor the notice mentions health shares. The test they set is HDHP coverage, and Hagopian writes that he took his family off their health insurance plan. A household in that spot can put new money into an HSA only if it still has HDHP coverage. Without it, the DPC carve-out never comes into play.

Money already in an account is a separate question. The notice says HSA amounts “may be used on a tax-free basis to pay or reimburse medical expenses,” and it treats qualifying DPC fees as reimbursable medical expenses. A family that leaves an HDHP for a health share can still spend down an old balance on its membership. It just can’t refill the account.

Where DPC fits

Hagopian’s essay describes two decisions that are easy to blur into one. The first is how a doctor practices: a flat fee, fewer visits a day, direct texting. The second is how a family pays for the hospital. DPC answers the first. It was never built to answer the second, and the 2026 HSA rule keeps them linked for anyone who wants the contribution break, because that break only works on top of an HDHP.

That shows up in the exam room. A patient who asks whether your fee can come from their HSA may also be asking, without saying so, whether they can drop their insurance. The fee question has a simple answer. The second one depends on whether they keep a qualifying high deductible plan.