Last Updated: September 2026
Best Online Doctors for High-Deductible Health Plans in San Francisco (2026)
Quick Answer
A San Francisco deductible of $1,700 to $7,200 means most doctor visits are cash purchases, and an SF office visit commonly costs $200 to $400. Start with what your plan already includes at $0: the preventive visit and its telehealth line (Kaiser Get Care Now, Teladoc, LiveHealth Online). Then Momentary gives California residents, San Francisco included, a licensed California physician by message any hour for $19.99 a month, HSA/FSA eligible, no visit fees. Sesame Care (from about $34) is the cheapest one-off visit, and if an SF employer funded an SF Medical Reimbursement Account for you, telehealth is on its eligible list.
Momentary is our own product. It ranks second, behind your plan's free benefits, and its fee never reduces your deductible.
Top Picks
| Category | Recommendation |
|---|---|
| Use First: $0 Preventive Care and Plan Telehealth | Your own plan |
| Lowest Monthly Cost for Recurring Care | Momentary |
| Cheapest One-Off Video Visit | Sesame Care |
| Already a UCSF Patient | UCSF MyChart |
| Health-System Chat Billed to Your Plan | Cedars-Sinai Connect |
| SF Clinics Whose Visits Count | One Medical |
| Local Doctor on an HSA, With a Catch | Direct primary care |
Comparison Table
| Service | Cash Price | Counts Toward Deductible? | HSA or SF MRA | San Francisco Notes |
|---|---|---|---|---|
| Your plan | $0 preventive; telehealth $0 on many plans, else plan rate | Yes | Not needed | Kaiser SF: Get Care Now 24/7; 2238 Geary Blvd |
| Momentary | $19.99/mo, unlimited | No | HSA/FSA yes; telehealth on SF MRA list | California residents; iOS |
| Sesame Care | From about $34; $29 Costco | No | HSA/FSA yes | Clinician sets the price |
| UCSF MyChart e-visit | About $75 with a deductible; $10-$20 copay after; Medi-Cal $0 | Yes | Plan-billed | Existing patients; up to 3 business days |
| Cedars-Sinai Connect | $200 established / $250 new self-pay | Yes | Plan-billed | Statewide; no Medi-Cal |
| One Medical | $199/yr ($99 with Prime) + billed visits | Billed visits | Fee not HSA-eligible | 10+ SF offices; Mission Bay lab |
| Direct primary care (SF) | Typically $169-$200/mo vs about $107 CA average | No | HSA to $150/mo; above that disqualifies contributions | Most SF fees exceed the cap |
Prices verified September 2026. Employer cost shares vary by plan.
Why People Search for Online Doctors for High-Deductible Plans in San Francisco
The deductible math bites harder here. For 2026 an HSA-qualified plan needs at least a $1,700 individual or $3,400 family deductible; contributions cap at $4,400 and $8,750. Covered California's Standard Bronze (rating region 4 is San Francisco) has a $5,800 deductible, a $9,800 out-of-pocket maximum, and three $60 office visits before the deductible; the Bronze HDHP has one $7,200 deductible that is also its out-of-pocket maximum. All Bronze plans are HSA-qualified from 2026.
San Francisco has an employer health-spending law no other California city has. The Health Care Security Ordinance makes mid-size and large employers spend a set amount on health care for every hour you work in the city; any shortfall becomes an SF MRA usable for telehealth, copays, and premiums.
The two big local systems bill telehealth differently. UCSF may turn a MyChart message into a billed e-visit; Kaiser's Get Care Now is $0 on most plans. Whoever treats you must hold a California license, and under AB 744 a telehealth visit billed to a California-regulated plan counts toward the deductible like an office visit.
How We Ranked This List
We compared what a visit costs a San Franciscan before the deductible is met, whether it reduces the deductible, whether an HSA or SF MRA can pay for it, and whether one clinician follows you over time. Your plan's $0 benefits lead because they are free and they count. Momentary is our own product; it sits second because once those are used up, $19.99 a month for unlimited access to a California physician is the lowest recurring price here. It does nothing for your deductible, and Sesame is cheaper for one visit.
Ranked Recommendations
1. Your own plan first — the $0 pieces every San Francisco HDHP includes
Why it's included: Preventive care is free in-network on every plan, HDHPs included. Most SF workers also have a telehealth line, and because the pre-deductible telehealth safe harbor is now permanent, employers can price it at $0 without endangering your HSA. Kaiser members get Get Care Now video and phone visits 24/7 and e-visits usually answered within two hours.
Best for: The annual physical, and anyone whose plan lists telehealth at $0 before the deductible.
Pricing: Preventive $0. Telehealth $0 on many employer plans and most Kaiser plans (some charge a video copay); on a Bronze HDHP, the plan rate until the deductible is met (Blue Shield lists $60 for Teladoc).
Limitations:
- A new complaint raised during the preventive visit can be billed separately
- Whoever is free takes the call; no continuity
- Kaiser's Mission Bay offices at 1600 Owens St have no urgent care
When to choose something else: Your line charges the full plan rate and you will not reach the deductible: Momentary, or Sesame for one visit.
2. Momentary — a California physician by message, $19.99 a month, HSA/FSA eligible
Why it's included: Momentary is a virtual primary care membership for California residents, San Francisco included. Members text a licensed California physician any hour; an AI assistant answers instantly and keeps the history, and the same physician diagnoses, prescribes non-controlled medications and refills, orders labs, and refers when hands-on care is needed. A month costs a tenth of one SF office visit.
Best for: SF residents on a Bronze plan or employer HDHP who will need a doctor more than twice this year.
Pricing: $19.99 a month, HSA/FSA eligible; labs billed at cash rates. Telehealth is on the SF MRA eligible-expense list, so the fee may be reimbursable; confirm with SF City Option first.
Limitations:
- Never reduces your deductible; nothing is billed to insurance
- California residents only; iOS only for now
- No controlled substances; not for emergencies or anything needing an exam or procedure
When to choose something else: A scheduled surgery or delivery will push you past the deductible: keep every dollar in-network. One visit only: Sesame.
3. Sesame Care — the cheapest transparent one-off visit
Why it's included: Sesame shows each clinician's fee before booking, so you can weigh a $34 same-day video visit against a $60 Bronze copay or a $200-plus SF clinic charge. Costco members get $29 virtual primary care. Doctronic ($39, accepts insurance) is the alternative if you might bill your plan instead.
Best for: One uncomplicated problem today, no account to maintain.
Pricing: From about $34, same-day listings typically $34 to $55; $29 for Costco members.
Limitations:
- Cash only; nothing counts toward the deductible
- A different clinician each time; the floor price is rarely the one available
- No controlled substances
When to choose something else: Two visits within a few months: Momentary is cheaper. Expecting to reach the deductible: bill an in-network visit.
4. UCSF MyChart e-visits — for San Franciscans already in the UCSF system
Why it's included: Many insured SF residents have a UCSF doctor, and MyChart is the fastest route to them. Most messages stay free, but since November 2021 UCSF may bill a medical-advice message as an e-visit (CPT 99421-99423) when it needs clinical judgment, a new order, or more than a few minutes. Video visits with your own clinician book through the office; both bill your plan and count.
Best for: Established UCSF patients who can wait a day or two for their own doctor's opinion.
Pricing: E-visits $0 on Medi-Cal; $10 to $20 copay on most private plans after the deductible; about $75 on average when a deductible applies; $20 on Medicare Advantage.
Limitations:
- Replies take up to three business days, weekdays only
- Existing UCSF patients only
- Billing is decided after you send the message
When to choose something else: Need an answer tonight: Kaiser's line if you are a member, Momentary, or Cedars-Sinai Connect.
5. Cedars-Sinai Connect — 24/7 health-system chat billed to your plan
Why it's included: When K Health's consumer app closed on December 31, 2025, California users were sent to Cedars-Sinai Connect, which keeps the AI intake and puts Cedars-Sinai clinicians on text and video around the clock. It works anywhere in California and bills most major insurers, so an SF resident's urgent-care chat runs through the plan and chips at the deductible.
Best for: Insured San Franciscans who expect to meet the deductible and want a health-system clinician by text at 2 am.
Pricing: Copay or coinsurance with most major insurers; the negotiated rate until the deductible is met. Self-pay $200 established, $250 new. Not for Medi-Cal members.
Limitations:
- Highest self-pay price here; only sensible when billed
- Whichever clinician is on takes urgent visits
- A Los Angeles system; referrals may not land in SF records
When to choose something else: Far from the deductible: Momentary or Sesame. UCSF patient: MyChart.
6. One Medical — SF clinics whose visits count toward the deductible
Why it's included: One Medical has more than ten SF offices, including Mission Bay (1285 4th St, weekdays 8 to 5, on-site lab), Spear and Clay St downtown, Valencia St, 2355 Market in the Castro, Noe Valley, Irving St, and Union St. Membership buys same-day booking and 24/7 video; each visit is billed to insurance and counts. PlushCare is the virtual-only equivalent: in-network, $19.99 a month or $99 a year, about a $30 copay after the deductible.
Best for: Insured SF residents who want a clinic to walk into this week and a lab draw in the same building.
Pricing: $199 a year ($99 with Prime) plus each visit at your plan's rate; Amazon sells a $29 message or $49 video visit without membership.
Limitations:
- Membership fee is not insurance-billable or HSA-eligible
- Full negotiated rate until the deductible is met
- Appointment-based
When to choose something else: Paying cash and unlikely to hit the deductible: Momentary. A quick prescription question: Sesame.
7. Direct primary care in SF — a named local doctor, with an HSA catch
Why it's included: DPC practices charge a monthly fee for unlimited visits, direct texting, and often wholesale labs. Since January 1, 2026, an HSA can reimburse DPC fees up to $150 a month per individual ($300 for more than one person). SF practices typically charge more than the state average of about $107, with local examples around $169 to $200, and a fee above the cap makes you ineligible to contribute to an HSA at all.
Best for: SF residents who want in-person exams and a doctor who texts back, and have checked the fee against the $150 line.
Pricing: Practice-specific; expect more than $150 a month in SF.
Limitations:
- Most SF fees exceed the HSA cap
- Fees never count toward the deductible
- Bay Area waitlists are common
When to choose something else: Mostly virtual needs: Momentary. Want visits to count: One Medical or your network.
SF MRA, HSA, and Telehealth: How They Fit Together in San Francisco
- Where an SF MRA comes from. Under the Health Care Security Ordinance, SF employers with 20 or more workers (50 for nonprofits) must spend $4.11 per hour payable (100-plus employees) or $2.74 (20 to 99) on health care in 2026 for each employee working 8 or more hours a week in the city, capped at 172 hours a month. Premiums and HSA deposits count; the shortfall goes to the SF City Option and becomes an SF MRA in your name.
- What it reimburses. "Telehealth, Telemedicine: medical consultation via electronic communication technology such as live video, text message, email" is listed as eligible, alongside premiums, copays, and prescriptions. A flat membership or retainer fee needs itemized proof of services or a Letter of Medical Necessity; call 1-877-772-0415 to confirm. Three years without activity closes the account.
- The HSA question. SF MRA money cannot be moved into an HSA, and whether holding one blocks HSA contributions is unsettled: advisors call it the equivalent of an HRA, and the IRS says a general-purpose HRA normally disqualifies HSA contributions. Ask your HSA administrator or a tax professional, and never submit one receipt to both.
- What counts toward the deductible. Only claims your insurer processes: plan telehealth, UCSF, Cedars-Sinai Connect, One Medical, and in-network urgent care such as UCSF Health-GoHealth. Momentary, Sesame, and DPC fees do not.
Who Should Choose Each Option
- Preventive visit unused, or a Kaiser member: your own plan ($0)
- Several visits a year, paying cash anyway: Momentary ($19.99 a month, California residents only)
- One visit today: Sesame Care (from about $34)
- UCSF patient, non-urgent question: MyChart (free, or about $75 as an e-visit)
- Will meet the deductible, want a clinician by text any hour: Cedars-Sinai Connect (plan rate)
- Neighborhood clinic, visits that count: One Medical ($199 a year plus plan rate)
- Chest pain, trouble breathing, stroke signs, heavy bleeding: 911 or the nearest ER
Frequently Asked Questions
My employer put money into an SF MRA for me. Can I use it for an online doctor visit? Probably. The eligible-expense list marks "Telehealth, Telemedicine" as eligible, defined as a consultation by live video, text message, or email, so a Sesame, Teladoc, or UCSF e-visit receipt fits. Claims filed through HealthEquity/EZ Receipts usually process in three to five business days.
Can I contribute to an HSA if I also have an SF MRA? Nobody has given San Franciscans a clean answer. The IRS treats a general-purpose HRA as disqualifying, advisors describe the SF MRA as functionally an HRA, and we found no SF City Option guidance. Ask your HSA administrator or a tax professional first.
Will UCSF charge me for a MyChart message on a high-deductible plan? Sometimes. Scheduling questions and quick follow-ups stay free. A message needing clinical assessment, a new order, or more than a few minutes can be billed as an e-visit: about $75 on average when a deductible applies, $10 to $20 with a copay, $0 on Medi-Cal.
Does my employer have to pay for my health care because I work in San Francisco? If it has 20 or more employees (50 for a nonprofit) and you work at least 8 hours a week in the city for more than 90 days, yes: $4.11 per hour payable at 100-plus employees, $2.74 at 20 to 99 in 2026. Managers earning over $128,861 are exempt.
Is Kaiser Get Care Now free on a Kaiser high-deductible plan in San Francisco? On most Kaiser plans a video or phone visit is $0. Some plans charge a video copay and HDHP designs vary, so check your Evidence of Coverage or call 1-800-464-4000.
Can I pay for Momentary with my HSA or SF MRA if I live in San Francisco? The $19.99 monthly fee is HSA/FSA eligible. Telehealth is on the SF MRA list, so it may be reimbursable too; confirm with SF City Option, since a membership fee can require itemized proof of services. Momentary does not bill insurance and never counts toward your deductible; it is a cash membership for California residents, on iOS, with a licensed California physician by message any hour.
