Why is my Health Spending Account card charged more than a regular debit card?

US HSA and FSA cards from HealthEquity, Optum, HSA Bank, Fidelity, and other administrators run through Visa or Mastercard rails but land in the healthcare merchant category code, which prices roughly 10 to 30 basis points above equivalent non-healthcare cards. On a flat-rate account the merchant pays the same rate regardless and the processor keeps the premium. On interchange-plus the premium flows through as a pass-through interchange line and Payzium's margin sits on top.

Will I have to change my practice-management software?

In most cases, no. US practice-management platforms typically support processor switching through open payment APIs. Bundled-payments platforms lock the payment side contractually; the boarding conversation covers the switching option in each case.

What about HIPAA and payment card data?

Card transaction data is not protected health information under HIPAA. The card networks and processors are governed by PCI-DSS, a separate compliance regime focused on payment card security. The practice's HIPAA obligations on the clinical data side are unchanged by the choice of payment processor.

How fast can I go live?

Standard file, standard state, standard specialty: boarded to processing within a business week from clean documents. Specialty clinics with unusual merchant-category codes take longer; the boarding conversation covers the timeline.

What is Pay less or it's free?

Payzium's US Savings Guarantee. If Payzium cannot lower the merchant's eligible processing cost against the merchant's prior baseline over the guarantee period, Payzium refunds or waives the Payzium fees covered by the guarantee. Approved eligible switching costs are reimbursed up to US$1,000. Requires documentation and approval. The written instrument is the governing document.

What happens on card-not-present patient billing?

CNP interchange prices above CP interchange at the same card. Program A charges 0.40 percent on the Payzium side of CNP, plus the actual CNP interchange. Compared to a flat-rate CNP rate at 3.3 percent, the delta on a heavy patient-pay-after-visit practice is substantial.

Independent practices

HSA and FSA cards are not regular debit. On a flat-rate account, your processor keeps the interchange premium.

US HSA and FSA cards from HealthEquity, Optum, HSA Bank, Fidelity, and other administrators route through the healthcare merchant category code, which carries an interchange premium above equivalent non-healthcare cards. Program A passes that interchange through at cost and charges 0.30 percent card-present margin on top, plus a $5 monthly account fee. Written on the pricing schedule.

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Interchange pass-through, in writing
Pay less or it's free
Honest Rate Promise
No junk fees

What you pay

A US practice on Payzium at typical volumes.

$273/mo
$20,000 monthly volume. About $3,557 a year less than Square USA.
$676/mo
$50,000 monthly volume. About $8,984 a year less than Square USA.
$1,597/mo
$120,000 monthly volume. About $21,861 a year less than Square USA.
$3,322/mo
$250,000 monthly volume. About $45,609 a year less than Square USA.

Math is for a debit-leaning healthcare card mix at $165 average ticket, 80 percent card-present. Payzium runs the same math on your own numbers before you sign.

Common patterns

Four cost mechanisms every US independent practice pays for.

01
Health Spending Account interchange premiums
US HSA and FSA cards from HealthEquity, Optum, HSA Bank, Fidelity, and other benefit administrators route through Visa or Mastercard rails but land in the healthcare-MCC interchange category. That category prices roughly 10 to 30 basis points above the equivalent non-healthcare card. On a flat-rate US processor, the merchant pays the same 2.6 percent regardless and the processor keeps the premium. On Program A the premium flows through as a pass-through interchange line and Payzium's 0.30 percent margin sits on top.
02
Patient-pay-after-visit keying
Balance-billing keyed transactions and portal-processed patient-pay run through card-not-present interchange, which prices meaningfully above card-present at the same card. Program A charges 0.40 percent on the Payzium side of card-not-present, plus the actual card-not-present interchange. Practices that bill 30 to 50 percent of revenue through the patient portal pay CNP rates on that slice on any account; on Payzium the CNP margin is 0.40 percent, not 3.3 percent.
03
Practice-management-software payment lock-in
Most US practice-management platforms (athenahealth, Dentrix, Eaglesoft, DrChrono, Practice Fusion, and specialty-specific systems) integrate with multiple payment processors. Some install with a preferred default and never change it. The Payzium boarding conversation covers the payment-integration terms plainly: which platforms plug in against Program A, which platforms lock payments contractually to a bundled processor, and what the switching options look like in each case.
04
Solo-practitioner statement noise
Standard US processor contracts include a monthly minimum fee, a monthly statement fee, and a PCI compliance line item. On a solo practitioner at moderate volume, the flat lines can add up to a significant share of the effective rate. Payzium's US-controlled billing is the $5 monthly account fee, plus per-transaction fees, plus margin. The Honest Rate Promise refunds any Payzium-controlled fee not on the pricing schedule.

What changes

Three US practices. Three switches.

Raleigh, NC
Family dental, 2 dentists
$95,000 per month, 50% HSA and FSA
On Square USA Free plan at roughly 2.6 percent blended. Paying roughly $2,514 per month on processing.
On Payzium Program A at 0.30 percent plus interchange. Paying roughly $832 per month.
$20,184
Lower annually
San Diego, CA
Solo dermatology
$40,000 per month, 65% patient-pay-after-visit
On Square USA Free plan at roughly 3.0 percent blended (CNP-heavy). Paying roughly $1,254 per month on processing.
On Payzium Program A at 0.30 to 0.40 percent plus interchange. Paying roughly $431 per month.
$9,876
Lower annually
Minneapolis, MN
Multi-specialist physiotherapy
$130,000 per month, integrated PM software
On Square USA Free plan card-present at 2.6 percent plus $0.15. Paying roughly $3,509 per month on processing.
On Payzium Program A at 0.30 percent plus interchange. Paying roughly $1,153 per month.
$28,272
Lower annually

Illustrative composite. Numbers reflect Payzium's published rates and typical practices card mix at the stated volumes. Not a real customer case.

Open account

The same published rate, however you sign up.

Step 1
Tell us about your medical
Business name, role, monthly volume, your POS.
Step 2
Boarding conversation
We confirm the pricing program and the qualifying device on the account before you sign.
Step 3
Sign and go live
Board on the pricing program that fits your practice. If your PM software supports open payment integration, Program A boards behind it. If the PM software is bundled, the boarding conversation covers whether the bundled software's contract permits payment migration and what the timing looks like.

Start your US application

No phone calls required. Rates are on /us/pricing.

FAQ

HSA and FSA cards are not regular debit. On a flat-rate account, your processor keeps the interchange premium.

A US practice on Payzium at typical volumes.

Four cost mechanisms every US independent practice pays for.

Health Spending Account interchange premiums

Patient-pay-after-visit keying

Practice-management-software payment lock-in

Solo-practitioner statement noise

Three US practices. Three switches.

The same published rate, however you sign up.

Tell us about your medical

Boarding conversation

Sign and go live

Frequently asked questions

Related US verticals.