Some variations on the concierge programs include:

Cash for Care Programs. Some of these programs are more designed around the doctor not accepting insurance payments. If these programs simply charge fees assuming cash payment, they work very well for HSA owners. Of course, an HSA owner can use his or her HSA to pay for qualified medical expenses billed by a doctor who does not accept medical insurance.
Retainer Fee/Amenities Program. This type of program charges an annual fee for access to a specific physician or physician group. Amenity items could include seeing a physician that has a limited number of patients, getting access twenty-four hours a day/seven days a week to that physician, and same-day or quick appointments. When you actually see the physician you or your medical insurance are still charged separately for that visit. These amenities are not likely to be considered qualified medical expenses as they relate to access not treatment. There is some room for debate on this interpretation and certainly some concierge service providers are stating that you can use your HSA to pay their fees because the fee is part of the medical service, but the conservative answer is that these amenities are NOT qualified medical expenses.
Hybrid Programs. Concierge medicine is an emerging area with a wide-variety of program offerings. One common hybrid offering is to provide the retainer/amenities program but also provide one physical included in the annual retainer fee. In this case, a portion of the fee is a qualified medical expense, the cost of the physical (and other included eligible medical services). If the program provides an itemized invoice (or you can find out the costs), you can use your HSA to pay for the annual physical but not the fee for access. There is also a potential timing issue with how these programs work and to be conservative you are best off paying the program fee with non-HSA dollars and then reimbursing yourself for the cost of the annual physical out of your HSA after you receive the physical.
Insurance Programs. Some of the programs operate more like insurance where you pay an upfront fee for an unlimited number of doctor visits/contacts and for limited (or unlimited) additional diagnostic and other services included. You generally cannot buy insurance with your HSA, so if the concierge medical program is considered insurance, you cannot use your HSA to pay for it and will also likely lose eligibility for an HSA).
Pre-Paid Medical Programs. Another approach to concierge medicine is closer to a pre-paid medical services model. You buy a package of services that includes a set number of visits and other medical services. Rather than paying separately, you buy a package. Assuming the services provided under this program are all qualified medical expenses you could use your HSA to pay for those expenses. Given uncertainly on how the rules for these services work the conservative approach would be to pay the program fee from non-HSA funds and then reimburse yourself from your HSA for the fair market value of each medical service received. If you do not take advantage of the all the medical services in the package you may not be able to reimburse yourself for the full cost of the package.

See also: HSA vs. HRA: Which is more popular?

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