---
title: Accepting HSA/FSA payments in health & fitness apps (US)
slug: hsa-payments-for-health-apps
summary: US health and fitness apps can let users pay subscriptions with pre-tax HSA dollars via Flex (RevenueCat integration) — Natal made tens of thousands of dollars in two weeks without announcing it, offering it on the annual plan with a trial; Ladder also rolled it out.
domain: mobile-apps
tags: [monetization, payments, hsa, health-fitness, web-checkout, us]
related: [external-payment-links-vs-iap, why-web2app-funnels, setting-initial-subscription-price]
sources: [yt:gqN6Z5WAeiI]
updated: 2026-10-24
---

# HSA payments for health & fitness apps

## TL;DR
- In the US, Health Savings Account (HSA) money is pre-tax; paying a subscription with it saves users roughly **30–40%** in effective cost (David Barnard's estimate).
- Natal launched HSA checkout via **Flex** (RevenueCat integration) and saw **tens of thousands of dollars** in ~2 weeks — **before announcing it**; users found it at checkout.
- Natal offers it **only on the annual plan**, with a free trial.
- Checkout is longer/more annoying (users select qualifying conditions, e.g. diastasis recti, pelvic-floor exercise), but the savings outweigh the friction.
- Push campaigns at **year end** — unused HSA/FSA-type dollars are use-it-or-lose-it.
- Opens a new segment: users who said they couldn't afford the app.

## Details
**Why Natal did it.** Natal (pre/postnatal fitness) sits between fitness and healthcare — corrective exercise and physical-therapy protocols. For years clients submitted receipts to insurance and told Nancy Anderson in DMs that it was covered; when HSA billing became possible she prioritised it immediately.[^1][^2]

**Results.** Launched ~2 weeks before recording; tens of thousands in revenue with zero promotion.[^3] The checkout asks users to choose conditions related to postpartum fitness; it's longer, but pre-tax money is a strong incentive. David switched his own Ladder subscription from App Store billing to HSA, calling it saving "30, 40 percent" on a subscription he already paid; he hypothesises retention will be better because it doesn't come out of the monthly budget.[^4][^5] Natal offers HSA only on the annual plan, with a trial.[^6]

**Who else.** Ladder rolled it out via the same RevenueCat–Flex partnership; David says very few apps accept HSA, and eligibility/classification is decided between the app and Flex.[^7][^8]

**Marketing angle.** Nancy plans to promote it in ads and content; David suggests end-of-year "don't lose your HSA dollars" campaigns. It also answers "I want your program but can't afford it".[^9][^10]

## Disagreements / caveats
- Regulatory and eligibility rules are US-specific and changing (David notes recent changes); confirm with the provider whether your app qualifies — general fitness may be treated differently from condition-specific programmes.
- Retention advantage is a hypothesis; no data yet at recording (May 2026).

## See also
- [[external-payment-links-vs-iap]] — another non-IAP billing path
- [[people/nancy-anderson]]

[^1]: yt:gqN6Z5WAeiI @ 52:16 — David Barnard, Nancy Anderson
[^2]: yt:gqN6Z5WAeiI @ 53:09 — Nancy Anderson
[^3]: yt:gqN6Z5WAeiI @ 53:56 — Nancy Anderson
[^4]: yt:gqN6Z5WAeiI @ 54:42 — David Barnard
[^5]: yt:gqN6Z5WAeiI @ 55:28 — David Barnard
[^6]: yt:gqN6Z5WAeiI @ 55:28 — Nancy Anderson
[^7]: yt:gqN6Z5WAeiI @ 57:05 — David Barnard
[^8]: yt:gqN6Z5WAeiI @ 57:50 — David Barnard
[^9]: yt:gqN6Z5WAeiI @ 56:15 — Nancy Anderson
[^10]: yt:gqN6Z5WAeiI @ 58:35 — David Barnard