The tax laws regarding the use of FSA and HSA cards are evolving. You cannot use an HSA to pay insurance premiums; prior to the Affordable Care Act, the monthly fee in a direct patient care practice was viewed in a similar way as an insurance premium. The ACA specified that direct primary care docs are not insurance companies, but the tax laws are evolving more slowly. You should consult with your accountant before using an FSA or HSA card to pay the monthly fee as the tax laws surrounding their use are expected to eventually change.