What Direct Primary Care Doctors Need to Know About the One Big Beautiful Bill Act (OBBBA)

The One Big Beautiful Bill Act (OBBBA) is officially in effect, and it’s packed with meaningful updates for Direct Primary Care (DPC) practice owners. From expanded tax deductions to long-overdue clarity on HSA eligibility, this legislation helps simplify practice operations and unlock new opportunities for growth.

Here’s what DPC doctors need to know.

HSA Eligibility for DPC Memberships

For years, DPC practices and patients faced uncertainty when it came to Health Savings Accounts (HSAs). The IRS offered little guidance on whether patients could use HSA funds to pay for DPC memberships, until now.

Starting January 1, 2026, DPC memberships will officially qualify as HSA-eligible medical expenses, as long as the monthly fee does not exceed:

• $150/month for individuals, or

• $300/month for families

These limits will be indexed for inflation over time.

Just as important, enrolling in a DPC membership under those thresholds will no longer disqualify patients from contributing to an HSA alongside a high-deductible health plan (HDHP). This change gives patients a clear and tax-advantaged way to access primary care and gives DPC practices a powerful new selling point.

What this means for your practice: You can begin offering HSA-eligible DPC memberships and market them to HDHP-covered patients starting in the 2026 plan year.

Bigger and Better QBI Deductions

If your DPC practice is structured as a pass-through entity like an S-corp, LLC, or sole proprietorship you’re likely familiar with the Qualified Business Income (QBI) deduction under Section 199A.

Here’s what’s new under OBBBA:

• The 20% QBI deduction is now permanent (it was previously set to expire after 2025)

• Phase-out thresholds have increased:

  • From $50,000 to $75,000 for single filers

  • From $100,000 to $150,000 for joint filers

• A new minimum deduction of $400 will apply for businesses with at least $1,000 of active QBI

These changes make the deduction more generous and accessible, especially for newer or smaller practices still building income.

What this means for your practice: More income qualifies for the 20% deduction, and you’re guaranteed at least $400 off your tax bill if you’ve earned even $1,000 in QBI. It’s a win for growing practices.

Better Treatment of Practice Debt

Planning to invest in your practice with a loan? Whether you’re expanding, buying equipment, or making improvements, OBBBA just made that investment more tax-efficient.

The bill permanently restores the EBITDA-based interest deduction limit, allowing businesses to deduct more interest on loans. Previously, deductions were capped based on taxable income, which restricted how much you could write off. Now, depreciation and amortization are added back into the equation—giving you more room to deduct.

And that’s not all: OBBBA also makes 100% bonus depreciation permanent. That means you can fully write off the cost of qualifying equipment and assets in the year they’re placed in service.

What this means for your practice: More interest and capital expenses are deductible, helping reduce taxable income and freeing up cash flow for growth.

Less Paperwork, More Flexibility

Beyond the headline items, the One Big Beautiful Bill Act includes a handful of business-friendly updates that simplify compliance and create new opportunities for tax planning:

• The 1099 filing threshold has increased to $2,000, meaning you’ll need to issue fewer forms to independent contractors and vendors.

• The above-the-line charitable deduction has been made permanent, so if your practice (or you personally) makes qualified donations, you can keep claiming that deduction.

• Opportunity Zones and New Markets Tax Credits are staying in place, offering continued tax incentives for practices expanding into underserved or low-income areas.

What this means for your practice: Lower administrative burden and new ways to reduce your tax liability, especially if you outsource services, donate to community initiatives, or operate in qualifying areas.

The Bottom Line

The One Big Beautiful Bill Act is a significant win for DPC practices. It finally offers clarity on HSA eligibility, solidifies key deductions, and reduces the complexity of running a small medical business.

Goodman CPA is here to help you take full advantage. Whether you're rethinking your fee structure, exploring entity options, or making growth plans, our team can walk you through the implications of this new legislation and help you build a more profitable, tax-savvy practice.

We work exclusively with DPC practices to simplify accounting, unlock deductions, and help you grow on your terms. Schedule a free consultation and let’s make the One Big Beautiful Bill Act work for you.