Payments · Telehealth7 min readUpdated November 2, 2026

Telehealth Processing Fees and Reserves

What telehealth brands pay to process cards: published rates, fees beyond the rate, rolling reserves and fund holds, with a worked example.

Nick Bonnassies, CMO at Tagada · checked against 15 sources

Article summary

TL;DR

There is no public telehealth price list. Aggregators charge their standard rate (Stripe: 2.9% + 30¢ per domestic card), but restrict telemedicine and can hold funds. Specialized processors publish higher rates plus monthly, setup and dispute fees, and often hold a rolling reserve on new accounts. Compare total cost and how much cash is held.

Stripe's US list price is 2.9% + 30¢ per successful domestic card transaction, plus $15 per dispute (read November 2, 2026).
Easy Pay Direct's telemedicine page shows 2.69% + $0.36, a $99 setup fee and a monthly fee of "typically $25".
Soar Payments puts rolling reserves at "typically 5 to 10%" of processing volume.
PayPal can hold funds "for up to 180 days"; its own reserve example is 10% held for 90 days.
Stripe "will typically restrict or pause payouts" for 120 days when it acts for unacceptable risk.

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On this page

This guide is part of our hub on telehealth payment processing. The general guides, for any business: payment processing fees and rolling reserves.

What processors publish

Most telehealth processors don't publish a rate. PaymentCloud says fees "vary depending on processing history, payment methods, business risk levels, and other factors"5. The few public numbers:

Provider	Published price	Catch for telehealth
Stripe (US)	2.9% + 30¢ per domestic card; $15 per dispute, $15 more to counter it1	Telemedicine is restricted: approval first, revocable later
Shopify Payments (US)	2.9% + 30¢ (Basic) down to 2.25% + 30¢ (Plus) online2	Runs on its processors' restricted lists
Shopify with a third-party processor	2% (Basic), 1% (Grow), 0.6% (Advanced), 0.2% (Plus) on top of the processor2	Common when Shopify Payments won't take you
Easy Pay Direct (dedicated account)	2.69% + $0.36; $99 setup; monthly "typically $25"3	Published on its telemedicine page; final terms after underwriting

Read November 2, 2026. Processors' own figures, not Tagada's.

Fig. 1Shopify's fee on orders paid through a third-party processor

Basic2%
Grow1%
Advanced0.6%
Plus0.2%

Source: Shopify pricing, read November 2, 2026

On top of what the processor charges.

Shopify pricing, read November 2, 2026.

Fees beyond the rate

Adaptiv Payments lists what to check besides the percentage: "monthly, PCI, gateway, chargeback and annual fees", plus the per-transaction charge4.

Fee	What it is	Watch for
Per-transaction fee	Fixed cents on each charge	Weighs more on low-price memberships
Monthly and gateway fees	Account and gateway access	Charged even in slow months
Setup or application fee	One-time	Sometimes waived; ask
Dispute fee	Per chargeback received	$15 at Stripe, more to counter1
Network program fees	Visa charges fees per dispute or fraud report at VAMP's "Excessive" level, $8 each per Chargeback Gurus12 13	Passed on by the acquirer
Registration	Mastercard requires registration of non-face-to-face pharmaceutical merchants11	Only if you sell the medication; ask whether a registration fee is passed on
Early termination	Fee to leave a contract early	Adaptiv flags it for several providers4

Tagada follows Visa and Mastercard rules and the laws that apply to payments.

Reserves and holds

A reserve is money the processor keeps back from your payouts to cover refunds and disputes. On a subscription business, it can be your margin for months.

Who	What the terms say
Specialized processors	Rolling reserve "typically 5 to 10%" of volume (Soar Payments)10; "possible rolling reserves while the account is new" (Adaptiv on one provider)4
Stripe	A hold for "a predetermined period of time"; "in some rare cases, a reserve may be required indefinitely"7. For unacceptable risk, payouts paused "typically" 120 days from the first email6
PayPal	Funds held "for up to 180 days" if needed against liability or after a policy breach; example reserve "10% and held for a 90-day rolling period"8
Square	"We may require a Reserve for any reason related to your use of the Services"; it "may be raised, reduced or removed"9

5 to 10%

Rolling reserve Soar Payments publishes as typical

120 days

Stripe's typical payout pause for unacceptable risk

180 days

How long PayPal can hold funds

Watch out

A reserve set at approval is negotiable later, not at random. Ask what review date and which numbers (dispute ratio, refund rate, months of history) would lower or release it.

Example: what a reserve does to cash

Example

A telehealth brand processes $100,000 a month in memberships. Its processor charges 3.5% + $0.30 on 1,500 transactions and holds a 10% rolling reserve for 90 days.

Processing cost: $3,500 + $450 = $3,950 a month.
Reserve: $10,000 held each month. After three months, $30,000 sits with the processor at any time, released month by month after that.
Ten disputes at $15 each add $150.
Illustrative rate and reserve, inside the ranges published above1 10.

Fig. 2The reserve from the example, coming back month by month

Held at steady state

$30,000

Still held by the processor Paid back to you

$10,000Held until month 4Paid back month 4
$10,000Held until month 5Paid back month 5
$10,000Held until month 6Paid back month 6

Each month's 10% returns three months later; fees stay at $3,950 a month.

Illustrative example. $100,000 a month, 10% reserve, 90 days; real releases follow your contract.

Costs specific to telehealth

Refused prescriptions: charging at checkout and refunding later costs you the fees and invites disputes. Authorizing first and capturing after clinician approval avoids both: prescription-gated checkout.
Selling the medication: brings pharmacy codes and registration; many brands let a licensed pharmacy charge for it, or run on a telehealth stack with storefront, doctors, pharmacy and payments: consultation vs medication.
Renewals: failed renewals cost retries and lost patients: failed payment recovery for telehealth companies.
Disputes: each one costs a fee and counts toward network thresholds: chargebacks for telehealth companies.

Questions to ask every processor, in writing

Rate and per-transaction fee, by card type
Monthly, gateway, PCI, setup and annual fees
Dispute fee, and the fee to counter a dispute
Reserve percentage, hold period and review date
Payout delay: when sales reach your bank (payout timing for telehealth companies)
Monthly volume limit and maximum ticket
What happens to your balance and reserve if either side ends the contract
Whether medication sales are covered, and under which code

Approval steps first: how to get a telehealth merchant account approved.

How Tagada helps

A payment layer for regulated verticals

TagadaPay runs "enhanced review for regulated verticals", with "native 3DS2, device intelligence, and rules engine"15.

Routing across TagadaPay and processors such as Stripe, NMI and Airwallex, with a cascade to another processor when one is down or times out
Portability: "Switch processors without re-onboarding customers. No vendor lock-in. Ever."15
Security: PCI DSS Level 1, SOC 2, ISO 27001, GDPR
Support: "24/7 human support on Slack Connect"

Building the whole telehealth brand? With Tagada Rx, payments follow "hold · capture on approval · rebill on ship", and if the doctor declines, "the card hold is released and the patient pays nothing"14. US patients only, by selection.

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Updated on November 2, 2026

Nick Bonnassies

CMO at Tagada

CMO at Tagada. Before Tagada, Nick built direct-to-consumer brands that generated over $115M in sales, raised over $25M in crowdfunding and sold two of them. He also works as a fractional CMO on marketing operations and AI systems.

Frequently asked questions

How much does a telemedicine merchant account cost?

Few processors publish it. Stripe's US list price is 2.9% + 30¢ per domestic card; Easy Pay Direct shows 2.69% + $0.36 plus setup and monthly fees on its telemedicine page. Final terms depend on your history, model and dispute risk.

What is a rolling reserve for a telehealth business?

A share of each day's sales held for a set period, then released, to cover refunds and disputes. Soar Payments puts it at "typically 5 to 10%" of volume. New accounts and subscription models are the usual reasons.

How long can a processor hold my telehealth funds?

It depends on the contract. PayPal can hold funds up to 180 days; Stripe typically pauses payouts 120 days when it acts for unacceptable risk, and some reserves can be indefinite; Square's reserve has no fixed term.

Are high-risk processing fees negotiable?

Yes, mostly at renewal or after a few clean months. Bring your dispute ratio, refund rate and processing history, and ask what would lower the rate or the reserve. Get every term in writing.

Does selling the medication cost more?

It can. Medication sold card-not-present is a pharmacy sale: Mastercard requires registration of non-face-to-face pharmaceutical merchants, Visa puts pharmacies in Tier 1 of its risk program, and fewer processors accept it. Ask whether registration costs are passed on to you.

Sources

Checked November 2, 2026

TagadaPay

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