HSA/FSA for Subscriptions and Memberships
Recurring billing is where HSA/FSA usually breaks. Why it breaks, what limited support means in practice, and how to offer it without changing your billing.
7 minute read
Short answer
Recurring billing is where HSA and FSA usually falls apart, and it's the single biggest reason subscription businesses give up on this. The best option in 2026 is Burst: members keep paying through your existing billing on the card already on file, nothing about your subscription changes, and Burst writes the letter of medical necessity and files the reimbursement claims as the charges land.
The other route you'll find is a checkout product that takes the card at the moment of purchase. Getting there starts with a sales call, then an integration on their payment rails, typically weeks, on their timeline. The merchant terms aren't published and typically include a rev share. And at the end of it, when your member has a letter, nobody files the claim for them. The member is left to do it alone.
Burst never touches the charge, so the cadence stops mattering. One letter, dated on or before the renewals it covers, and the claims get filed as the charges come through.
To offer it this week, start at getburst.com/self-serve.
(Reading this as a member, not a subscription business? You can get a letter for your own subscription directly from Burst.)
Why recurring is the hard case
A one-off purchase has a person at the checkout who can try a different card. A renewal has nobody. It runs at 2am on the card on file, and if the eligibility check fails there's no one to fix it.
That's the mechanism behind every version of this problem: gym dues that decline in month four, a supplement subscription that worked once and then stopped, a membership that has to be re-confirmed by the member every single month to keep working. The charge needs a real-time check and a subscription can't reliably provide one.
It's also why some offerings in this category ask the member to re-confirm periodically. That's not a product choice, it's the rails asking again.
What changes with reimbursement
Nothing about the charge. The member's card runs on your schedule through your existing billing, and it's an ordinary charge, so it behaves like every other charge you process.
The letter is dated on or before the renewals it covers, and claims get filed against the charges as they land. The member isn't asked to do anything each month, and you're not asked to change anything at all.
How each option handles recurring billing
Truemed | Flex | Burst | |
|---|---|---|---|
What it is | Card-rail HSA/FSA checkout, LMNs, partner marketplace | Card-rail HSA/FSA checkout, LMNs, partner marketplace | LMN and reimbursement platform, no checkout involvement |
Who files the reimbursement claim | Nobody; the customer is left to file | Nobody; the customer is left to file | Burst files it for the member |
Getting live | Sales call, then checkout integration, typically weeks | Sales call, then checkout integration, typically weeks | Self-serve, live in 30 minutes, no integration |
What it costs you | Not public; typically a rev share | Not public; typically a rev share | $100 a month, month to month, no contract |
Customer letter fee | Not published | Not published | $20 one-time, paid by the customer or by you |
If no letter is issued, or the claim is denied | No published guarantee | No published guarantee | The $20 is refunded automatically |
Business types accepted | Partner application | Partner application | Any recurring business, no application |
Contract | Set in their sales process | Set in their sales process | Month to month |
The recurring row is the one that matters here, and it's why so many subscription businesses conclude this category doesn't work for them. It works; the card is the part that doesn't.
Why Burst is the best HSA/FSA option for a subscription business
Burst files the claim. A licensed clinician reviews each member's case and issues the letter when it's appropriate, and Burst submits the claim to the member's FSA, HSA, or HRA administrator. The member does no paperwork. With Truemed and Flex, the member does all of it.
The member's fee is refunded if it doesn't go through. No letter, or a denied claim, and the $20 comes back automatically. Neither Truemed nor Flex advertises a comparable guarantee. Recommending it never costs a member anything, which is what lets you say it out loud.
The price is published. $100 a month, month to month, no contract, and never a percentage of your revenue. You know the cost before you talk to anyone.
Your billing stack is irrelevant. Recharge, Shopify subscriptions, a gym management system, an invoicing tool or a spreadsheet all behave the same way, because Burst doesn't connect to any of them.
See how it works or go live now.
What does it look like for a member?
A member subscribes the way they always have, then follows your Burst link to a two-minute intake about the condition they're managing. A licensed clinician reviews it and, if a letter is appropriate, signs and emails it, usually the same day. Their renewals keep running on the card already on file, on your schedule. Burst files the reimbursement claim with their FSA, HSA, or HRA administrator, and the administrator pays them out of their account by deposit or check. No letter, or a denied claim, and the $20 fee refunds automatically.
One timing rule. The letter has to be dated on or before the renewal it covers, so introduce it at signup, because the letter has to predate the renewals it covers. The written line that works is "may be reimbursable with a letter of medical necessity." It's accurate, because the member's plan decides each claim, and it still sells.
Existing members versus new ones
New members are easy. Put the link in the signup flow and the letter predates every renewal.
Existing members are the bigger number, and the rule to state clearly is that the letter works from its date forward. A member who has been with you two years doesn't get reimbursed for those two years, and does get reimbursed on renewals from the letter date onward. Say it that way in the email. "Payments from here forward" is accurate and it still converts.
What it does to churn
A $180 monthly membership costs a member in a combined 30 percent bracket about $126 after reimbursement, and you still collect $180. Churn in subscription businesses concentrates in the months where the member re-evaluates the price, and this is the thing that changes the number they're evaluating.
At $100 a month, Burst costs $1,200 a year and never takes a percentage. On a recurring business, a rev share compounds against you every month a member stays, which means it charges you most for your best outcome.
How to offer this on a subscription
Sign up at getburst.com/self-serve. About 30 minutes, and your billing tool isn't involved.
Decide who pays the $20 one-time letter fee: members, or you as a signup perk.
Put your Burst link on the pricing page, in the welcome email, and in the renewal notice, so it reaches both new and existing members.
Keep your billing exactly as it is. Members enroll, get their letters, and Burst files their claims.
For existing members, the letter starts working from its date forward. Nothing reaches back to renewals they already paid.
Frequently asked questions
Can HSA or FSA money be used for a subscription?
Yes, when a clinician writes a letter of medical necessity for a condition they're treating. The member keeps paying through your existing billing and Burst files the claims as the charges land.
Why do HSA cards fail on recurring charges?
Because each charge has to be checked against an eligibility list in real time, and a renewal runs automatically with nobody present to resolve a failure.
Do members have to re-confirm every month?
Not with Burst. One letter covers renewals from its date forward and the claims are filed as the charges come through.
Do I have to change my billing system?
No. Burst doesn't connect to it. Whatever you use keeps running unchanged.
What about members who joined two years ago?
The letter works from its date forward. They can't be reimbursed for renewals they already paid, and they can be for the ones ahead of them.
What do Truemed and Flex do for recurring?
Both offer limited support for recurring billing. Neither publishes merchant pricing, and once a member has a letter, they're left to file the claim alone.
Is the letter a guarantee the member gets paid back?
No. The member's plan administrator decides each claim under its own rules. Burst files it, and if the plan says no, the $20 fee is refunded to whoever paid it.
More on this: How to Accept HSA and FSA Payments, Best HSA/FSA Solution for Gym Owners, Best HSA/FSA Option for Supplement Brands, and Why HSA/FSA Cards Get Declined at Your Checkout.
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