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Accepting HSA/FSA payments in health & fitness apps (US)

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.

Updated 2026-10-24·1 source·monetizationpaymentshsahealth-fitnessweb-checkoutus

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.12

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.45 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.78

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”.910

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

Footnotes

  1. How Removing the Free Trial Grew Monthly Subs 2000% – Nancy Anderson, Natal @ 52:16 — David Barnard, Nancy Anderson ↩

  2. How Removing the Free Trial Grew Monthly Subs 2000% – Nancy Anderson, Natal @ 53:09 — Nancy Anderson ↩

  3. How Removing the Free Trial Grew Monthly Subs 2000% – Nancy Anderson, Natal @ 53:56 — Nancy Anderson ↩

  4. How Removing the Free Trial Grew Monthly Subs 2000% – Nancy Anderson, Natal @ 54:42 — David Barnard ↩

  5. How Removing the Free Trial Grew Monthly Subs 2000% – Nancy Anderson, Natal @ 55:28 — David Barnard ↩

  6. How Removing the Free Trial Grew Monthly Subs 2000% – Nancy Anderson, Natal @ 55:28 — Nancy Anderson ↩

  7. How Removing the Free Trial Grew Monthly Subs 2000% – Nancy Anderson, Natal @ 57:05 — David Barnard ↩

  8. How Removing the Free Trial Grew Monthly Subs 2000% – Nancy Anderson, Natal @ 57:50 — David Barnard ↩

  9. How Removing the Free Trial Grew Monthly Subs 2000% – Nancy Anderson, Natal @ 56:15 — Nancy Anderson ↩

  10. How Removing the Free Trial Grew Monthly Subs 2000% – Nancy Anderson, Natal @ 58:35 — David Barnard ↩