Subscription-based healthcare just got a big tailwind from the OBBB

I’m still digesting the impact of the ‘One, Big, Beautiful Bill’ - for better or for worse. But I did want to share that there is a standout feature of the legislation, which in my view heavily favors the trajectory of companies that sell subscription-based healthcare services to members. One industry friend is calling it the “MAHA dividend for digital health,” so let’s unpack it.

Going forward in 2026, direct primary care memberships will now be recognized as qualified medical expenses that can be paid for with pre-tax HSA dollars. With this change, individuals can sign up for a direct primary care and use their HSA, or separately the employer could newly subsidize it on behalf of their employees who are enrolled in a high-deductible health plan and contributing to an HSA. That’s millions of people.

For those of you who might not know exactly what a direct primary care membership is: A Direct Primary Care (DPC) membership is a healthcare payment model where patients pay a flat monthly or annual fee directly to a primary care provider for access to a set range of services, bypassing traditional insurance.

You pay a flat fee (usually $50–$150/month per person). In return, you get unlimited access to your primary care provider for no additional cost.

“This is the craziest tailwind for our company ever,” said Danish Nagda, founder and CEO of Rezilient, a company that works with hundreds of employers to offer direct primary care.

For those not familiar with direct primary care, it’s a way for a member to pay monthly or annually to access a primary care doctor or clinic - instead of using insurance. A lot of people in my network like this approach, because insurance - particularly in a fee-for-service construct - can lead to some dynamics that patients do not like. For instance, patients seem to love using asynchronous methods, like SMS messaging with their care team, but insurance provides higher reimbursement rates for video and in-person visits. Providers are drawn to it because it removes the administrative hassles associated with taking insurance.

I’ve already hit the phones this week asking several jumbo employers and policy experts in my network about this policy change. It’s a very big deal in my opinion for companies in the longevity space, direct primary care businesses, and really any company that offers primary care on a recurring, subscription basis.

These changes will be in effect from Dec. 31, 2025. Per Lockton:

Under the OBBB, direct primary care service arrangements are not disqualifying coverage for HSA account holders and certain expenses are HSA-eligible expenses effective for months beginning after Dec. 31, 2025. Generally, direct primary care services include a monthly fee that covers office visits prior to the satisfaction of the HDHP deductible. These monthly fees are now HSA-qualified expenses, provided they do not exceed $150 per month for an individual or $300 for family (indexed for inflation annually.

For larger employers, this provides direct primary care as an option for many more members and it will bolster enrollment in it, particularly for employees on high deductible plans and those accessing care on the individual market.

This will certainly boost businesses with direct-primary-care models, but could spill over into categories like longevity (for ex. Parsley Health and Lifeforce ) or pediatrics startups (ex. Summer Health and Blueberry).

My complete analysis on who this benefits, and how, is available to paid subscribers here on Second Opinion