Flexible spending accounts can't be used to pay for concierge membership fees

Flexible spending accounts are operated by employers

Unlike health savings accounts, which can be opened at banks and credit unions, FSAs are employer-owned and operated—meaning you can only access an FSA through an employer benefit, and the account doesn't follow you if you move jobs. To use an FSA to pay for a medical service or product, purchases typically have to be uploaded, approved, and then employees can be reimbursed.

Explore a list of surprisingly FSA-eligible wellness products

Flexible spending accounts can be used to cover medical expenses, but those funds can also be used to purchase wellness items or services, like bandages or contact solution. The general guidance for what's FSA eligible is any expense that is designed to diagnose, cure, mitigate, or treat a medical condition. HSA funds can often be used to cover the same expenses. (Some users may experience a paywall.)

As healthcare costs have increased post-COVID, critics have been skeptical about the real impact HSAs/FSAs have had in alleviating medical expenses

Health savings accounts and flexible spending accounts are designed to be tax-advantaged ways for people to save money on healthcare and medical expenses. But one recent study found that HSAs can increase families' total out-of-pocket spending on healthcare by more than $500 per year.

Concierge services are one of the top medical costs retirees fail to factor into their planning

One of the unexpected medical costs retirees are facing is thousands of dollars a year for concierge care membership fees. A typical annual fee can average $3,500. Concierge care is an option that's particularly popular among older adults with more complex health needs and in some areas of the country doctors are increasingly turning away Medicare patients and only accepting new patients willing to pay annual fees for concierge medicine. (Some users may experience a paywall.)

Dependent care flexible spending accounts allow people who care for someone incapable of self-care to use pretax dollars to support the dependent person.

Primary care doctors are converting into membership-based concierge practices

Subscription-based practices sometimes don't accept insurance and they also require annual membership fees which can add up to thousands of dollars per year. In return, patients are promised more personalized care and round-the-clock access to medical providers. As doctors transition to concierge care, this retainer-based medicine model is forcing people to choose between searching for new primary care providers or paying hefty fees.

Annual memberships for concierge medicine can be $1,000 or as much as $50,000

Concierge medicine practices offer more opportunities for same-day visits and longer meeting times with doctors in exchange for annual membership fees on top of typical insurance payments, copays, and deductibles.

Employers get to keep any FSA funds not used by the annual deadline

Flexible spending arrangements have use it or lose it deadlines defined in the plan. Employers that offer FSAs get to keep any unused funds, but that money has to go towards administering the FSA program. Remaining FSA funds can also be pooled and divided evenly amongst a company's FSA participants, but very few companies actually do this.

Amazon's One Medical, MDVIP, and SignatureMD are examples of concierge practices

Annual fees for concierge practices can range widely. At the lower end, Amazon's One Medical costs $199 (which can drop to $99 if you're a Prime member) and four figures for MDVIP and SignatureMD. Annual fees jump to $10,000 or more for options like Massachusetts General Hospital's concierge practice.

HSA spending spikes early in the year, while FSA spending peaks in December

Because health savings accounts are designed to alleviate high upfront costs for people with high deductible health plans, the majority of HSA spending happens early in the year. However, around 10% of flexible spending account funds are used in December—right before the use it or lose it deadline.

US concierge and direct primary care practices surged 83.1% between 2018 and 2023

Research published in December 2025 in the journal Health Affairs indicates that these retainer-fee care models are expanding across the country. Concierge medicine charges monthly or annual fees, as does direct primary care (which doesn't take insurance).

Concierge medicine practices typically have hundreds of patients, instead of thousands

A clinician describes how he's "one call away" from his patients in the concierge medicine system. His patients pay about $150 per month to be members in his practice on top of normal care visit costs. Doctors like him may only have hundreds of patients in their practice—instead of thousands.

HSAs are frequently criticized for exacerbating inequality in healthcare access

Health savings accounts offer large tax advantages, but require personal contributions. Some argue that the tax advantages benefit wealthy individuals more than anyone else and that HSAs don't do much to help people who can't afford to regularly contribute to one. As a result, HSAs only decrease costs for those who can comfortably invest in them, and health inequalities between high-income and low-income individuals are exacerbated.

Health savings accounts are designed to alleviate upfront costs for high-deductible health plans.

Watch a breakdown of tax breaks most Americans don't know about

Programs like healthcare savings accounts or flexible spending accounts are tax-free accounts that are designed to help lower healthcare costs. However, many Americans don't use them and don't understand how they work.

Health savings accounts evolved out of medical savings accounts introduced in the 1990s

After medical savings accounts in Singapore and South Africa proved successful, the US introduced a pilot program for small business owners and the self-employed to pair with high-deductible health plans in 1996. In 2003, Congress passed a law inspired by that program, and health savings accounts became tax-free and open to anyone with a high-deductible plan. FSAs, on the other hand, date back to the 1970s.

The Government Accountability Office in 2005 concluded concierge medicine didn't threaten Medicare

This congressionally mandated analysis concluded that the number of concierge physicians nationwide was too small for concierge practices to undermine Medicare patients' access to affordable health care and it was "unlikely that the approach has contributed to widespread access problems." Medicare is the federal health insurance program for the aged and some disabled individuals.

Older, medically complex patients are a high proportion of concierge practices, a membership-based model which is sometimes referred to as retainer medicine or VIP medicine.

Concierge care may account for more than 10% of primary care physicians

That's the rough estimate from Zirui Song, a Harvard Medical School professor who focuses on health care policy and studies the growth of concierge medicine. He and other researchers found that between 2018 and 2023 the number of concierge and direct primary care practices (concierge care without accepting insurance) grew by 83% and the number of clinicians in those practices increased by 78%.

Concierge medicine offerings are growing on college campuses, catering to students

Parents are interested in concierge and direct primary care services for their kids, including offerings with dorm visits, guaranteed same-day appointments, and medication access, so new practices have sprung up catering to college settings. (Some users may encounter a paywall.)

Critics of concierge medicine argue it's worsening physician shortages and expanding inequity

Some research suggests that the average wait time for a primary care visit in major US cities can be 21 days. Subscription-based medical practices offer faster in-person and virtual appointment options, but the price barrier to this type of service may worsen inequity in healthcare access. (Some users may experience a paywall.)

Doctors report wanting more time to plan, provide care for patients

Many physicians experience aspects of burnout, and concierge medicine provides a slower, more relational approach to medicine, including consistent follow-up care for a smaller pool of patients. A concierge medicine clinician may talk with each patient frequently, perhaps every few weeks, instead of just once a year.

HSAs are triple-tax advantaged—offering tax-free contributions, investments, and withdrawals

One of the reasons HSAs are so popular is the plan's triple-tax advantage. All contributions to an HSA happen pretax, funds in the HSA can be invested in stocks, bonds, or exchange-traded funds, and withdrawals to cover medical expenses are tax-free.

Virtual care—telehealth—is a significant component of concierge medicine

Telehealth—a central plank of concierge medicine—can widen the gap between the rich and the poor since lower-resource individuals may have less access to technology and encounter other access issues.

By 2036, the US may face tens of thousands of primary care physician shortages

That's the estimate of the Association of American Medical Colleges, which contends that whenever physicians switch to concierge medical practices it exacerbates this projected shortage since each of those clinicians will see fewer patients and those patients must be able to afford that pricey care.

Trump's 2025 'One Big Beautiful Bill Act' expanded access to health savings accounts

After the "One Big Beautiful Bill" took effect, Medicare users with bronze or catastrophic level health plans, as well as certain medical care membership models and telehealth users, became eligible for HSAs. Supporters of HSAs say expanding access to this savings program is more effective in alleviating high consumer costs than subsidizing healthcare plans or direct treatments.

Concierge medicine officially began in 1996, with the first concierge practice

MD2 International, a concierge medical office that opened in Seattle, Washington, was founded based on the idea of unrushed, no-wait-time visits and personalized care offerings with strong relationships between patients and their providers.

American Express runs on a 'spend-centric' model, using perks and merchant fees to drive profit

American Express cardholders tend to spend more money per transaction than other credit card users, which makes the interchange fees merchants have to pay to accept American Express cards worth it while incentivizing other companies to pay the interchange fee as well.

One estimate values concierge services at $38.9B by 2032

Data Horizons Research put the value of this global market at $18.9B in 2021, but anticipates massive growth by 2032, with North America comprising the majority of the market. Chronic health conditions, their analysis suggests, will be a contributing factor to this growth as medically complex individuals seek more personalized care.

Roughly 45% of clinicians in 2023 reported at least one symptom of burnout

With that kind of statistic as a backdrop, proponents of concierge medicine practices argue that concierge services could help keep doctors in medicine and thus help to address physician shortages.

The scope of 529 plans has expanded, but 529s still have some drawbacks

The tax-advantaged accounts can be used to pay for K-12 education, apprenticeship programs, and student loans, in addition to their original purpose: paying for college. But 529s have downsides, such as fees and penalties for non-qualified uses.

American Express intentionally targets wealthy cardholders, who spend higher amounts per transaction and tend to make more transactions than the average cardholder, thereby reducing the company's risk.

The Platinum American Express card is among the most expensive mainstream travel credit cards

American Express charges a $895 annual fee on its Platinum Card in exchange for nearly $3.5K worth of credits and benefits. Some of the credits include a $600 for hotels, a $400 credit at restaurants with Resy, a $300 Lululemon credit, and even a $200 credit at Oura ring. (Some users may experience a paywall.)

529 plans can affect college financial aid

Income affects FAFSA financial aid determinations. FAFSA also takes 529 college savings plans into account. The percentage of savings it uses in its calculations depends on who owns the account (parent, student, or someone else). Other schools use a program called CSS to determine financial aid, and those determinations vary.

Fees can eat away at your 401(k)

Every investment plan has an expense ratio—a percentage of the total assets that goes to the investment manager in the form of fees. Because 401(k) plans are so common, and many of their participants are not savvy investors, the relative expense ratio for them has often excessively increased.

In 2025, American Express paid $230M to settle fraud and deceptive marketing charges

American Express launched a wire payment service targeted at small businesses and falsely touted the service as a tax-deductible business expense in 2018. American Express was also accused of allowing small businesses to open corporate credit cards without the necessary employer identification number (EIN).

529 plans have some withdrawal penalties

The IRS imposes a 10% penalty on non-qualified withdrawals from 529 college savings plans, which hold funds for education-related expenses. However, there are exceptions to the rule, including if the beneficiary dies or becomes disabled. There's also an exception for beneficiaries that receive tax-free scholarships or attend military academies.

There are two main types of 529 plans

One type of 529 plan, prepaid tuition plans, can only be used to pay for tuition. The other type, college savings plans, can also be used to pay for related education expenses, including room and board. One key advantage of a prepaid tuition plan is that it locks in tuition prices. Both types have limited options for non-educational uses.

Some argue that America is too dependent on consulting

Many major companies in America—not to mention the federal government—spend thousands of dollars a month paying to contract major consulting firms.

How “superfunding” a 529 account works

Contributions to 529 college savings accounts incur gift taxes if they exceed preset annual limits. However, “superfunding” allows donors to contribute five years’ worth of the gift tax limit to a 529 account in one lump sum without paying additional taxes. That means individual donors can pay $90K into a 529 plan at once and still be exempt from gift taxes.

Support groups are typically free, which makes them widely accessible

The groups are typically run by someone with the same illness or set of experiences and can provide clear, practical knowledge about navigating healthcare resources, bureaucracy, and more. Since they function on trust, however, there are no legal confidentiality prohibiting people from sharing what's discussed. What's more, group leaders may not be uniformly trained or certified.

Read about the situations where a high-yield savings account doesn't make sense

While financial experts often recommend high-yield savings accounts, one expert argues that prioritizing adding more money to one doesn't make sense for someone who has a lot of high-interest debt or isn't taking advantage of their company's 401(k) match.

Six bills experts say you shouldn't put on autopay

Autopay has plenty of benefits, such as helping to avoid late fees and streamlining your bill paying process. But some experts say there are a few types of bills that you shouldn't autopay, especially if you're not confident you can pay these bills in full each term. The list includes utility bills and annual subscriptions. Read the full list here.

American Express has acquired restaurant software companies to elevate its cardholder experience

One of the many perks of American Express cards is dining credits and special reservation access to fine dining restaurants. Since American Express cardholders are often more affluent than other credit card users, restaurants have benefited from increased partnerships with American Express to offer cardholders preferential reservations and premium experiences. In 2019, American Express acquired Resy, a reservation software, and went on to acquire Tock in 2024.

Congress didn't renew temporary enhanced Affordable Care Act federal subsidies that expired at the end of 2025, a move that substantially raised ACA health insurance premiums.

Federal spending falls into 2 categories: mandatory and discretionary

Federal spending is split between mandatory programs, funded automatically by law, and discretionary programs, funded through annual appropriations. This video breaks down which major programs fall into each category and why the distinction matters.

Managing too many credit cards can be costly if they have annual fees

However, canceling cards must be strategic if it becomes necessary, as it can negatively impact your credit score. Before canceling, experts suggest asking if it's possible to downgrade to a no-annual-fee version in order to keep the account open, thus preventing potential hits to your credit score.

The Social Security Administration (SSA) accounted for 22.4% of all federal spending in 2024

The SSA is an independent executive branch agency that is primarily responsible for administering Social Security benefits. In fiscal year 2024, The SSA, ranking second among federal agencies in terms of total spending, behind only the Department of Health and Human Services.

Who actually pays for your credit card rewards?

In 2018, 92% of all credit card spending was made on a rewards card, which seems like a good deal to many who apply for rewards cards offering discounted flights, points, and more. But in actuality, the customers are often the ones who end up paying for the rewards in the grand scheme of things.

13 things Medicare gives you for free

Even people on Medicare, the US government health insurance program for people 65 and older, have to pay for their own co-pays and prescription drug costs. But other services, like alcohol counseling and colorectal screenings, may be free for Medicare recipients. To learn about 11 more things that are free with Medicare, scroll through this list.