Visa's healthcare rows: lower rates on balances of $500 or more
FSA and HRA benefit cards are built to work at providers with a healthcare merchant code [3], and charging a stored card costs more than a card in hand (Square lists 3.5% + 15¢ against 2.6% + 15¢) [5]. Visa's interchange table includes Healthcare rows that apply to sales of $500 or more. In the office, the rate is 1.43% + 5¢ on most card types, including Visa Signature and traditional rewards cards, and 2.30% + 10¢ on Visa Infinite spend-qualified and Signature Preferred cards [1]. For payments taken without the card present, such as online or by phone, it is 1.53% + 5¢ on most cards [1].
Compare that with Visa's standard rows. A basic card in the office is 1.51% + 10¢, a Visa Signature card is 1.65% + 10¢, and a basic card online is 1.89% + 10¢ [1]. On a $650 balance paid online, the healthcare row saves about $2.39 against the standard online row.
Small practices get the same healthcare rates under Visa's Small Merchant program, which lists Healthcare at 1.43% + 5¢ on most cards for businesses with $280,000 or less in Visa consumer credit sales [1]. Which row your sales land in depends on how your processor set up your account, so check that your statement shows healthcare rows on large balances.
FSA and HRA cards at the front desk
Flexible spending and health reimbursement cards are restricted debit cards. The IRS rules that govern them limit their use to "physicians, pharmacies, dentists, vision care offices, hospitals, and other medical care providers," identified by healthcare merchant category codes [3]. Stores without a healthcare code can take these cards only if they run an inventory system that checks each item [3].
For a practice, that means FSA and HRA cards should simply work if your account carries a healthcare merchant code. If patients report declines on benefit cards while other cards go through, ask your processor which merchant category code your account uses. Drug stores and pharmacies have their own path, either an item-checking system or registering under what the industry calls the 90% rule [4].
Health savings account (HSA) cards are tied to the patient's own account and plan. If one declines, the patient should check their balance and plan rules with the card issuer; it is rarely something your front desk can fix.
Keeping a card on file: consent first, and know the price
Many practices ask for a card at check-in and charge the balance once insurance pays. That is a stored card, and Visa's rules require cardholder consent before you store it the first time [6]. Use a written or electronic consent that says when you will charge it and up to how much, and give the patient a copy.
Charging a stored card is a card-not-present sale, and it costs more. Square charges 3.5% + 15¢ for a card on file, against 2.6% + 15¢ for a tapped card [5]. On interchange, Visa's standard online row is 1.89% + 10¢ against 1.51% + 10¢ in the office [1], though balances of $500 or more can use the healthcare row instead.
One month of post-insurance balances
A practice charges 120 stored cards a month with an average balance of $180.
At Square's card-on-file rate (3.5% + 15¢), that is $774 in fees [5].
If the same patients paid by tapping a card at checkout (2.6% + 15¢), it would be $579.60 [5].
Collecting more balances at the visit, when estimates allow, saves the difference.
Should a practice add a card surcharge?
New Jersey allows a credit card surcharge up to the seller's actual cost to process the payment, with notice posted at the point of entry and point of sale before the patient is charged [7]. Visa caps it at your processing rate for that card or 3%, and does not allow surcharges on debit or prepaid cards [8], which includes many benefit cards.
Your payer contracts may also limit what you can add to a patient's bill. Check them, and ask your own counsel, before posting a surcharge sign. This is general information, not legal advice, as of Oct 20, 2026.
New Jersey practices
New Jersey had 7,756 offices of physicians and 4,511 offices of dentists with paid employees in 2023 [2]. Most collect a mix of small copays and larger balances, which is exactly where the healthcare rows and the card-on-file price gap matter.
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