Payments · Telehealth6 min readUpdated November 2, 2026

Payment Methods for Telehealth Companies

Which payment methods fit a telehealth checkout: cards and wallets, HSA and FSA cards, BNPL and ACH, and which suit hold-then-capture and refills.

Nick Bonnassies, CMO at Tagada · checked against 11 sources

Article summary

TL;DR

Cards, Apple Pay and Google Pay do most of the work: they fit both a hold-then-capture checkout and automatic refills. Add HSA and FSA cards if your processor uses an eligible medical MCC, and keep a backup card on file. Treat BNPL and ACH as extras: Affirm doesn't support recurring payments, and ACH can't hold funds before capture.

Cards, Affirm, Klarna, Afterpay, Cash App Pay and PayPal support separate authorization and capture on Stripe; ACH doesn't (read November 2, 2026).
Stripe accepts HSA and FSA cards for qualified medical services under an eligible MCC, but issuers "can still authorize or decline" them.
On Stripe, Affirm accepts healthcare services "subject to additional requirements", starts at $35 and doesn't support recurring payments.
Nacha's unauthorized ACH return threshold is 0.5%, measured over 60 days or two calendar months.
In 2025, the FTC alleged a telehealth company debited bank accounts on a recurring basis without written authorization.

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On this page

This guide is part of our hub on telehealth payment processing. The general guide, for any business: payment methods for high-risk merchants.

Methods at a glance

A telehealth checkout has two constraints a retail one doesn't: you often hold the payment until a clinician decides, and many plans renew. Each method handles those differently.

Fig. 1Each method, at the hold and at the renewal

Method	Hold, then capture	Automatic renewals	What to watch
Cards	Yes1	YesAs stored credentials	Card network dispute and fraud thresholds
Apple Pay, Google Pay	YesAs card payments	Depends on your setup	Same as cards
HSA and FSA cards	YesAs card payments	Possible, but balances run out	MCC eligibility, issuer decides2
Affirm	YesManual capture4	No4	$35 minimum, healthcare requirements4
Klarna	Yes1	Check your setup	Stripe's restricted list applies too5
ACH bank debit	NoSeparate authorization1	YesWith authorization	Nacha return thresholds7

Cards and wallets cover both steps. ACH skips the hold.

Stripe Docs on holds, HSA/FSA cards, Affirm and Klarna; Nacha.

Cards and wallets

Cards carry the hold-then-capture flow and the renewals. Wallets ride on the same rails and cut typing on mobile, where many patients book.

Same rails as cards
Apple Pay and Google Pay are card payments: the hold and capture work the same way.
Liability shift
Wallet payments can carry cryptograms that also support the 3D Secure liability shift in some cases9.
Checkout friction costs sales
In Baymard's survey, 17% of US shoppers who abandoned an order cited a too long or complicated checkout (updated September 22, 2025)10.

Fraud checks for card payments: fraud prevention and 3D Secure for telehealth.

HSA and FSA cards

Patients often want to pay with health savings or flexible spending cards. Whether they work depends first on how your business is classified.

Your situation	What Stripe says
You provide qualified medical services	Use an HSA/FSA-eligible MCC; no further registration needed2
You also sell products	IIAS certification, SIG-IS registration and Visa and Mastercard registration2
Either case	Issuers "can still authorize or decline payments as they would with any other type of card"2

The IRS describes FSA and HRA debit cards that work at merchants "that have merchant category codes related to health care", or through an inventory approval system3. Which expenses are eligible is a tax and plan question: don't promise it at checkout.

Watch out

An HSA or FSA card on a renewing plan can fail mid-year when the balance runs out. Ask for a backup card at sign-up. More on these declines: reducing payment declines for telehealth companies.

Buy now, pay later

BNPL providers underwrite you on top of your processor, and their limits matter more than their buttons.

Affirm (on Stripe): "Healthcare services are approved to use Affirm, however they're subject to additional requirements"4. Minimum $35, domestic only, manual capture supported, recurring payments not supported4.
Klarna (on Stripe): Stripe's prohibited and restricted list applies on top of Klarna's own; "Direct marketing" is prohibited5.
Use case: a larger one-time purchase, such as a multi-month plan paid up front. Not a monthly membership.

ACH bank debit

ACH costs less than cards and suits renewals, but it doesn't fit the clinician-review step: on Stripe, ACH doesn't support separate authorization and capture1.

Rule	What it means for you
Nacha unauthorized returns: 0.5% threshold7	Patients who don't recognize a debit can push you over
Unauthorized returns up to 60 days after settlement8	A refill can come back two months later
NoRetry of an unauthorized return without new authorization8	Get a fresh authorization, don't re-debit
Written authorization for recurring debits	The FTC's NextMed order requires authorization before preauthorized transfers6

Fig. 2What a renewing plan can charge

A renewing telehealth planCharged without the patient at checkout

CardsYes, as stored credentials
Apple Pay, Google PayDepends on your setup
HSA and FSA cardsPossible, but balances run out
ACH bank debitYes, with written authorization
AffirmNo recurring payments

Hide anything that can't renew on a plan that renews.

Stripe Docs, Affirm payments; Nacha; FTC NextMed order.

Use ACH after approval, for renewals or a prepaid plan, with a clear recurring authorization stored with the order.

PayPal

PayPal's position on telemedicine depends on its Acceptable Use Policy and your account review. We haven't documented it here. What we know about PayPal and Square for this category: do PayPal and Square allow telehealth.

Which to show, in which order

Card form first, with a clear "hold, not charge" line if you capture after review.
Apple Pay and Google Pay above the card form on mobile.
HSA and FSA as a note under the card form, if your MCC supports them, with a backup-card prompt.
Affirm or Klarna only on one-time purchases above their minimum.
ACH only for renewals or prepaid plans, after approval.

Order of the payment options on a telehealth checkout that captures after review.

The checkout itself, field by field: checkout optimization for telehealth companies. Wallet buttons and one-tap flows: express checkout for telehealth companies.

How Tagada helps

Wallets, 3DS2 and routing at the telehealth checkout

TagadaPay brings "Native 3DS2, device intelligence, and rules engine: approve real customers, block the rest"11, with "Enhanced review for regulated verticals."

Checkout with Apple Pay and Google Pay, one-click upsells and order bumps.
Routing across TagadaPay and processors such as Stripe, NMI and Airwallex, with one logic, and a cascade to another processor when one is down or times out.
Your vault, portable: "Switch processors without re-onboarding customers."

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

Building a telehealth brand from scratch? Tagada Rx includes payments that hold at checkout, capture on approval and rebill on ship. US patients only, by selection.

Apply for processing

Wallets, 3DS2 and routing at the telehealth checkout

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

Can telehealth companies accept HSA and FSA cards?

Often, if the processor classifies you under an HSA/FSA-eligible medical MCC. Stripe says businesses providing qualified medical services can accept them that way, while product sellers need IIAS and SIG-IS steps. Issuers can still decline, and eligibility of the expense is the patient's plan question.

Can patients pay for telehealth with Affirm or Klarna?

Sometimes. On Stripe, Affirm accepts healthcare services subject to additional requirements, from $35, and doesn't support recurring payments. Klarna follows Stripe's restricted list plus its own. Use BNPL for larger one-time purchases, not monthly plans.

Does Apple Pay work with a hold-then-capture checkout?

Yes. Apple Pay and Google Pay are card payments, so you can authorize at checkout and capture after the clinician approves, within the authorization window, about 7 days for an online customer-initiated payment. They also speed up mobile checkout.

Can I bill a telehealth subscription by ACH?

Yes, after approval and with a clear recurring authorization. ACH doesn't support a hold before capture on Stripe. Unauthorized returns can come up to 60 days later, and Nacha's threshold for them is 0.5%.