Direct primary care fees count toward deductibles in state plans

Relating to the inclusion of direct primary care fees as qualified medical expenses applied toward insurance deductibles in certain state health benefit plans.

Introduced· 2025-03-07

Who's it for

Who's it for: Everyday People

What it means for you

8/10Helps you

Good for everyday people ·

Draft summary, still being checked against the official bill text. Read the source to confirm.

If passed, Texas state health plans would let you apply direct primary care fees toward your insurance deductible, lowering what you pay out of pocket.

Our take

What we think, in plain words.

State workers and teachers could see lower medical bills because their primary care payments count before insurance kicks in, but insurers may face higher costs and the rule‑making could be slow.

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The facts

What the bill actually says, no spin.

Direct primary care fees include monthly retainer, membership, subscription, or per‑visit fees.
The bill applies to participants in the Employees Retirement System of Texas and Teacher Retirement System of Texas health plans.
Fees counted as qualified medical expenses would apply to the deductible.
The board of trustees must adopt rules to implement the change.
The act takes effect September 1, 2025 for plans starting January 1, 2026.