Should Your Medical Practice Accept and Promote HSA and FSA Payments?

A dermatology office called us in early November, a little panicked. A competitor across town had just run a simple email that said use your FSA before you lose it, and their own front desk was suddenly fielding calls asking if they took FSA too. They had taken it for years. They had just never told anyone. In three weeks the other clinic booked out its December calendar on treatments people had been sitting on all year. Same patients, same money, one practice said something and the other did not.

This is one of the most overlooked opportunities in a medical practice, and it hides behind a simple question owners ask us all the time: should we accept HSA and FSA, and is it worth making a fuss about it? The short answer is yes and yes. The longer answer is why it works, and why almost nobody does it well.

First, the easy part: can you even accept them?

Yes, and it is simpler than most owners assume. An HSA or FSA card is just a regular Visa or Mastercard tied to a special account. It swipes, taps and dips through the exact card reader you already use. There is no new terminal, no separate contract, no extra fee to turn anything on. If the visit is a qualified medical expense, the card works like any other. Most eligible services, a crown, a skin treatment, a round of physical therapy, an eye exam, run through without a second thought.

So the ability is not the issue. The awareness is. Which brings us to the part that actually moves your schedule.

Why promoting it matters so much

Here is the thing patients forget: this is money they have already decided to spend on health. They put it aside, pre tax, on purpose. It is sitting there. And a huge chunk of it never gets used.

Roughly half of FSA holders forfeit unused funds back to their employer every year. In one large analysis of 3.2 million accounts, about 52 percent of accountholders lost money, an average of $441 each, according to the Employee Benefit Research Institute. Add it all up and workers hand back billions of dollars a year in FSA money they were allowed to spend on care and simply did not. Because FSA balances are use it or lose it, most plans wipe whatever is left at year end.

HSAs work differently, they roll over and grow, but the pile is enormous. Nearly $147 billion sits in those accounts right now, per Devenir research, and the market is projected to top $199 billion by 2027. Every one of those dollars is earmarked for exactly the kind of care your practice provides.

Now picture your patient. They have a dental issue they have been ignoring, or a mole they keep meaning to get checked, or back pain they push through. They also have several hundred dollars in an account they barely think about. Nobody has connected those two facts for them. Your job, and your marketing's job, is to connect them out loud.

What patients can actually use it on

The eligible list is much longer than most patients think, and educating them is half the win. Qualified medical expenses generally cover a lot of what independent practices do:

• Dental: cleanings, fillings, crowns, and orthodontics like braces and clear aligners.
• Vision and eye care: exams, glasses, contacts, and LASIK.
• Dermatology: medically necessary skin treatments and procedures.
• Physical therapy and chiropractic: visits and treatment plans.
• Mental health: therapy and counseling sessions.
• Med spa with a medical purpose: some treatments qualify, though purely cosmetic ones usually do not.
• Everyday care: copays, deductibles and many out of pocket visit costs.

Rules vary by plan, and purely cosmetic work is generally excluded, so the honest move is to tell patients the good news and point them to check their own plan. The IRS list of qualified medical expenses is the source of truth. But you do not need to be a tax expert. You just need to raise your hand and say we take these, and here is what they cover.

How to actually market it (the part that books visits)

Accepting HSA and FSA is passive. Promoting it is where the schedule fills. Here is what works.

1. Put it in plain sight on your website

Add one clear line to your homepage, your booking page and any service page for eligible treatments: we accept HSA and FSA cards. That sentence answers a question the patient was already wondering and removes a reason to hesitate. It is a small trust signal with outsized impact, especially on the pages where people decide to book. If your site does not make payment and booking obvious, that is a bigger leak than most owners realize, and it is exactly the kind of thing we fix when we build websites that convert.

2. Run a year end campaign, because the clock is real

This is the big one. From October through December, FSA money is on a countdown. Patients feel it. A simple email to your list that says do not lose your FSA, book before December 31 lands because it is true and it is urgent. Pair it with a few targeted ads on Meta and Google, and you fill the slow holiday weeks with treatments people were already going to want. We covered the broader playbook in how to promote a service at your practice, and the same urgency mechanics apply here, only stronger, because the deadline writes itself.

3. Wake up patients you already have

The warmest audience for this is your own past patients. The person who came in once for a consult and drifted off, the family that has not been back in a year, the patient who wanted a treatment but said not right now. A friendly reminder that their benefits reset soon and their funds are waiting brings a lot of them back. This is some of the cheapest revenue you will find, and it pairs perfectly with the ideas in reactivating past patients and leads and email marketing for medical practices.

4. Lean on it for cash based and elective services

If you run a cash based, membership or elective model, HSA and FSA are a genuine competitive edge. Price sensitive patients relax when the money comes from a pocket that was already set aside for health. Feature it prominently anywhere you sell services out of pocket. It is a natural companion to the thinking in marketing a cash based practice and to offering payment plans, because both lower the felt cost of saying yes.

Our honest take

We will be blunt about where practices go wrong here. Owners treat HSA and FSA as a billing detail, something the front desk knows and nobody advertises. That is a mistake. It is not a billing detail, it is a marketing message, and a powerful one, because it does something rare: it makes the patient feel like booking is smart rather than expensive.

The catch is that a message only works if it reaches people. Taping a little sign to the front desk does nothing for the patient searching for you at 9pm from their couch. The clinics that win with this are the ones that say it everywhere the patient actually is, on the website, in the inbox, in the ad, before the year end deadline hits. That is not extra work you bolt on in December. It is a small, repeatable play that belongs inside a real patient acquisition system, running every fourth quarter like clockwork.

And do not overthink the compliance side. You are not giving tax advice. You are stating a fact, we accept these cards, and pointing patients to check their own plan. Keep it honest and simple. The honesty is part of why it works.

So, should you do it?

Yes. Accept HSA and FSA, because it costs you nothing and runs through the reader you already own. Then, more importantly, promote it, because there is a mountain of pre tax health money sitting idle and a hard December deadline that turns hesitation into booked visits. Put the message on your site, send the year end reminder, wake up your past patients, and let the calendar do the persuading. The practice that says something wins the patient. The one that stays silent watches that money go back to an employer, or to the clinic across town that spoke up first.