How To Use Your HSA More Strategically In 2026
Most people with a health savings account are doing the same thing: depositing money, watching the balance grow, and telling themselves they'll use it eventually. Dental visits, maybe a pair of glasses. The rest sits there, collecting interest they never think about, backing up a healthcare plan they mostly ignore until something goes wrong.
That pattern made sense when HSAs were limited to co-pays and deductibles under traditional insurance. It makes less sense now. As of January 1, 2026, under IRC Section 223, HSA funds can be used to pay for direct primary care memberships, including the labs and medications that come with them. That is a significant change, and most people haven't heard about it yet.
New for 2026: HSA funds can now pay for your direct primary care membership under IRC Section 223. If you have an HSA and a high-deductible plan, this changes the math.
The most strategic thing you can do with an HSA right now is pair it with a direct primary care membership -- using pre-tax dollars to cover the one healthcare relationship that actually reduces your spending everywhere else.
This article breaks down how HSAs work, what the 2026 change means in practical terms, and how business owners and employees in the Fort Mill and Charlotte area can build a smarter healthcare structure around it.
What an HSA Actually Is (and Why Most People Underuse It)
A health savings account is a tax-advantaged account available to people enrolled in a high-deductible health plan (HDHP). The triple-tax advantage is real: contributions go in pre-tax, the money grows tax-free, and withdrawals for qualified medical expenses aren't taxed either. No other savings vehicle works that way.
The catch is that HDHPs, by design, come with higher out-of-pocket costs before insurance kicks in. For 2025, the minimum deductible for an individual HDHP is $1,650, and for a family it's $3,300. So employees who enroll in an HDHP to lower their monthly premium often end up delaying or skipping care because they don't want to pay out of pocket until they hit that deductible. They have an HSA with money in it, and they're still avoiding the doctor.
An HSA doesn't solve the access problem. It solves the payment problem. The access problem is what direct primary care is built for.
The result is a pattern that doesn't serve anyone well: people deferring care until something is serious enough that it costs more to fix, with a tax-advantaged account sitting full and untouched.
What the 2026 HSA Rule Change Means for You
The rule change that took effect January 1, 2026 is straightforward. Under IRC Section 223, direct primary care membership fees are now a qualified HSA expense. That includes the monthly membership itself and, depending on your plan, the wholesale labs and medications that DPC members access through their practice.
Before this change, DPC memberships occupied an awkward gray area. DPC is not insurance, and the IRS had not formally classified it as an HSA-qualified expense. That created uncertainty for both patients and employers who wanted to offer DPC alongside an HDHP.
That uncertainty is resolved. If you have an HSA and you're currently paying for a DPC membership out of pocket, you can now use pre-tax dollars to cover it. And if you're an employer structuring benefits for your team, this changes the math on pairing an HDHP with a DPC membership as your primary benefit offering.
One important note: patients and employers should confirm the eligibility of specific expenses with their HSA plan administrator, as plan terms vary. The federal change establishes the legal basis -- but your specific account's administrator has final say on reimbursement.
How Direct Primary Care Makes Your HSA Work Harder
Direct primary care is a membership model for primary care. You pay a flat monthly fee, your provider handles the large majority of what you need day to day, and there are no co-pays or per-visit charges for services covered under your membership.
At New South Family Medicine in Fort Mill, SC, DPC membership for an individual adult is $129/month. That covers same-day and next-day appointments, direct text and phone access to your provider, longer visits where you actually have time to talk, chronic disease management, and access to wholesale-priced labs and medications that run significantly below retail rates.
The structure that works for most HDHP enrollees is this: keep the HDHP for hospital and specialist coverage, pair it with a DPC membership for everything routine and preventive, and fund the membership through the HSA. The HDHP premium is lower, the DPC membership covers the vast majority of what you actually use, and the HSA dollars that used to sit unused are now covering a care relationship that delivers real access.
For most people with a high-deductible plan, DPC isn't an add-on. It's the layer that makes the high-deductible plan livable.
A real comparison: one urgent care visit in the Charlotte area typically runs $150-250 out of pocket before you hit your deductible. A full month of DPC membership, with unlimited same-day access, runs $129. The math starts to make itself.
What Else You Can Use Your HSA For at New South
DPC membership is the most significant change, but it's not the only place HSA dollars are worth directing. Several services at New South are HSA and FSA eligible -- and the DPC member discount means the combination stretches further than either one alone.
Services patients commonly apply HSA and FSA funds toward at New South include:
Integrative functional testing programs: Advanced lab panels and root-cause assessments that go beyond standard bloodwork. Priced from $250 for an initial consultation, with a 20% DPC member discount bringing that to $200.
The 12-Week Physician-Led Wellness Program: A clinically supervised program with physician oversight, advanced diagnostics, and a full coaching team. HSA and FSA funds may be applied -- patients confirm with their plan administrator. DPC members receive a 20% discount, bringing the investment from $4,500 to $3,600.
BHRT (Bioidentical Hormone Replacement Therapy): Lab fees and clinical follow-up visits for patients managing perimenopause, menopause, or andropause symptoms. DPC members pay $65 for hormone repeat labs versus $75 for non-members.
The 20% DPC member discount across wellness and integrative functional testing programs means the membership pays for itself before you ever account for avoided urgent care visits. Confirm specific HSA and FSA eligibility for each service with your plan administrator -- New South can provide documentation upon request.
For Business Owners: How This Changes Your Benefits Math
If you're a small business owner in York County or the Charlotte MSA, you've felt what rising group premiums do to your benefits budget. Employers with 10-100 employees have watched per-employee healthcare costs climb year after year while their teams still struggle to get a timely appointment.
To put numbers to it: the average employer in the Charlotte MSA was spending $580-650 per employee per month on group premiums in 2024, according to KFF employer benefits survey data. At New South, the DPC group rate for five or more employees is $100 per employee per month. Paired with a lower-premium HDHP -- where group premiums typically run $300-400 per employee per month versus $580+ for a traditional plan -- the combined cost often comes in at or below what employers were already spending, with meaningfully better access for employees.
The HDHP plus DPC structure offers a practical alternative. Employers pair a lower-premium high-deductible plan -- or in some cases eliminate group insurance entirely in favor of a QSEHRA or ICHRA allowance -- with a DPC membership at $100 per employee per month for teams of five or more. Employees get same-day access and a provider who actually knows them. The HSA rule change means those employees can fund the DPC membership pre-tax if they're enrolled in an HDHP.
Compatible benefit structures include:
HDHP + HSA + DPC: The most common pairing. Lower premiums, HSA for DPC costs and incidentals, DPC for routine and preventive care.
QSEHRA: For employers with fewer than 50 employees who don't offer group insurance. Provide a monthly healthcare allowance employees use for their own HDHP and DPC membership.
ICHRA: An individual coverage health reimbursement arrangement that works across employer sizes. Employees choose their own coverage, employers fund the allowance.
Self-insured or self-funded with stop-loss protection: For employers comfortable with more direct risk management, paired with DPC to reduce claims frequency.
In each model, the employer controls the cost, the employee has real healthcare access, and the 2026 HSA rule change makes the employee's contribution more tax-efficient.
For Fort Mill, Rock Hill, Indian Land, Tega Cay, Lake Wylie, and Charlotte business owners who are already sending employees to New South as individual DPC members, the B2B group rate of $100/employee/month is a natural next step -- and often a conversation that starts from an existing patient relationship.
Frequently Asked Questions
Q: Can I use my HSA to pay for a direct primary care membership?
A: Yes, as of January 1, 2026, under IRC Section 223, DPC membership fees are qualified HSA expenses. This applies to the monthly membership fee. Labs and medications accessed through your DPC practice may also be eligible -- confirm specific expenses with your HSA plan administrator, as terms vary by account.
Q: Does a DPC membership replace health insurance?
A: No. Direct primary care is not health insurance and does not replace it. DPC covers the large majority of routine, preventive, and primary care needs. Patients still need insurance for hospitalizations, specialist referrals, and emergency care. DPC works alongside insurance, not instead of it.
Q: What is the DPC membership cost at New South in Fort Mill?
A: Individual adult membership at New South Family Medicine is $129/month, with a one-time $200 enrollment fee. For employers with five or more employees, the group rate is $100/employee/month with no enrollment fee at the employer level. Children ages 5-22 with an enrolled parent are $59/month.
Q: Can my employer contribute to my HSA if I'm enrolled in DPC?
A: Employer HSA contributions are tied to HDHP enrollment, not DPC enrollment. If your employer offers an HDHP and contributes to your HSA, those contributions are yours to use for qualified expenses -- including, as of 2026, DPC membership fees. Confirm current contribution limits and qualified expense definitions with your benefits administrator.
Q: Is a high-deductible health plan required to open an HSA?
A: Yes. To contribute to a health savings account, you must be enrolled in an IRS-qualified high-deductible health plan. The HDHP and DPC pairing works well together because the HDHP keeps premiums low while the DPC membership provides affordable day-to-day primary care access.
Q: Are wellness programs and integrative testing at New South HSA-eligible?
A: HSA and FSA eligibility for wellness programs and integrative functional testing depends on the specific program and your plan terms. Patients should confirm with their HSA administrator before applying funds. New South can provide documentation of services upon request.
Q: Where can I learn more about DPC benefits near Fort Mill or the Charlotte area?
A: New South Family Medicine is located at 441 Mercantile Place, Suite 101, Fort Mill, SC 29715 and serves patients across York County, Indian Land, Tega Cay, Lake Wylie, and the greater Charlotte area. Schedule a complimentary Meet and Greet to learn how DPC membership works and whether the HDHP plus DPC structure makes sense for you or your team.
Conclusion
The 2026 HSA rule change is one of the more practical developments in employer healthcare in recent years. For individuals, it closes a gap that kept HSA dollars from funding the one relationship that reduces spending everywhere else. For business owners, it makes a HDHP-plus-DPC benefits structure more accessible and more attractive to the employees considering it.
If you're running a team of five to a hundred employees in the Fort Mill or Charlotte area and you've watched your benefits costs rise while your team's access to care stayed flat, the conversation is worth having.
Schedule a business consultation with New South Family Medicine to walk through what a DPC benefit structure would look like for your headcount, your current plan, and your team.
If you're ready to put your HSA to work with a primary care membership that actually earns it, a complimentary Meet and Greet is the right first step. No enrollment pressure -- just a conversation about what DPC looks like for you.
Schedule Your Complimentary Meet and Greet
If you're a business owner exploring how a DPC benefit structure could work for your team, we're happy to walk through the numbers with you.
