Open enrollment is the one time each year when most families can change their health coverage. If you are comparing plans this fall, you have probably noticed that lower premiums usually come with higher deductibles. A high-deductible health plan (HDHP) paired with a health savings account (HSA) and a direct primary care membership can be a smart way to balance cost and access to care. Here is how the three fit together.
What Is a High-Deductible Health Plan?
An HDHP has lower monthly premiums than a traditional plan, but you pay more out of pocket before insurance starts covering most costs. For 2027, the IRS defines an HDHP as a plan with a deductible of at least $1,750 for individual coverage or $3,500 for family coverage, and an out-of-pocket maximum of no more than $8,700 for individuals or $17,400 for families.
Starting in 2026, bronze and catastrophic plans bought through the health insurance marketplace are also treated as HSA-compatible, which gives more families access to an HSA.
What Is a Health Savings Account (HSA)?
An HSA is a savings account for medical expenses that comes with three tax advantages: contributions are tax-deductible or pre-tax, the money grows tax-free, and withdrawals for qualified medical expenses are tax-free. Unused money rolls over every year and stays with you if you change jobs.
- 2027 contribution limit for individual coverage: $4,500
- 2027 contribution limit for family coverage: $9,000
- Extra catch-up contribution if you are 55 or older: $1,000
The catch with an HDHP is that everyday care, like a sick visit or a checkup for a chronic condition, can feel expensive until you meet your deductible. That is where direct primary care comes in.
What Is Direct Primary Care?
Direct primary care (DPC) is a membership model. Instead of billing insurance for each visit, you pay a simple monthly fee that covers your primary care. At Summit Direct Health in Tooele, members get unlimited visits, direct access to their provider by phone or text, and same-day or next-day appointments when available. Learn more about how a direct primary care membership works.
New for 2026: You Can Use Your HSA for Direct Primary Care
For years, having a direct primary care membership could make you ineligible to contribute to an HSA. That changed on January 1, 2026. Under the One Big Beautiful Bill Act and follow-up IRS guidance, a qualifying direct primary care arrangement no longer affects HSA eligibility, and you can pay your membership fees with HSA dollars, as long as the fees stay at or below $150 per month for an individual or $300 per month for a family.
Summit Direct Health monthly membership fees are within those dollar limits:
| Membership | Monthly fee |
|---|---|
| Kids ages 0 to 17 (enrolled with an adult) | $25 |
| Adults ages 18 to 24 | $45 |
| Adults ages 25 to 45 | $95 |
| Adults ages 46 and older | $105 |
| Family | $295 |
Because the rules have specific requirements, check with your HSA administrator or a tax professional about your situation.
How the Three Work Together
1. Your membership covers everyday care
Sick visits for things like colds, flu and other acute conditions, follow-ups, chronic condition management and preventive conversations are covered by your monthly fee. No copays, no waiting to meet a deductible.
2. Your HDHP protects you from big expenses
Your insurance is there for the costs a primary care clinic cannot cover, such as emergency room visits, hospital stays, surgery, specialists and advanced imaging. Once you hit your out-of-pocket maximum, the plan covers the rest.
3. Your HSA ties it together
Use pre-tax HSA dollars for your membership fees, prescriptions, lab work and deductible costs. Whatever you do not spend keeps growing for future health needs.
Is This Combination Right for Your Family?
An HDHP with an HSA and a DPC membership often works well for:
- Families who want predictable costs for everyday care
- Self-employed workers and small business owners buying their own coverage
- Healthy adults who rarely need hospital care but want easy access to a doctor
- People managing a chronic condition such as diabetes or high blood pressure who need regular check-ins
It may be less ideal if you expect a major surgery, a pregnancy or ongoing specialist care this year. In that case, compare the total cost of each plan option, including premiums and out-of-pocket maximums.
Open Enrollment Checklist
- Compare the premium, deductible and out-of-pocket maximum of each plan
- Confirm whether a plan is HSA-eligible
- Estimate what you spend each year on routine care and prescriptions
- Add up what a direct primary care membership would cost for your household
- Plan your HSA contributions for the year
- Ask your HSA administrator how to pay or reimburse DPC fees
Questions? We Are Happy to Help
Choosing a health plan is a big decision. If you would like to see how a Summit Direct Health membership could fit with your coverage, review our membership pricing, schedule a free consultation or call us at (435) 500-2688.
This article is for general information only and is not tax, legal or insurance advice. HSA rules can change. Please talk with a qualified tax professional or benefits advisor about your situation.
