The visit package: sizing the discount and holding the floor

How much should the discount be?

The number comes out of your own arithmetic, because no agency, statute or fee schedule prices a package of visits and nothing published sets a safe percentage. Three figures decide it: the posted cash rate for one visit, the per-visit cost floor underneath it, and how much of the gap between the two you will trade for money collected early. The rest of this page is that trade, priced.

The floor comes first, because it is the only figure in the calculation that comes out of your own books. The Small Business Administration's startup worksheet splits a practice's spending into one-time costs and recurring monthly ones, and tells an owner to count at least a year of the recurring side 1Ref 1U.S. Small Business Administration (2026).Plan your business — Calculate your startup costs.The split of practice overhead into one-time and recurring monthly expenses and the instruction to count at least a year of the recurring side, used here as the input to a per-visit cost floor.. A year of that, divided by the visits a year of your calendar holds, is the price floor.

But the floor only tells you where to stop.

The discount is the distance you travel from the posted rate down toward it, and what you get for the trip is money now plus a patient committed to a course of care. Price the package at the floor and you have sold the whole course for the cost of delivering it.

Worked against a posted rate of $200 and a floor of $170. The percentages below are an illustrative convention; no authority publishes one.

The ten-pack carries the deepest discount, and at these numbers it earns nothing per visit. Its entire margin is whatever goes unredeemed, which prices the practice on patients not turning up.

The tax lands the year the card runs

Collecting six visits in December and delivering five of them in the spring does not split the tax bill across two years. A cash-method practice, which is the default for a solo owner carrying no inventory, includes in gross income everything it receives actually or constructively during the tax year 2Ref 2Internal Revenue Service (2022).Publication 538 (Rev. January 2022) — Accounting Periods and Methods.The cash-method rule that income actually or constructively received during the tax year is included in gross income that year, the one-year ceiling on the accrual-method advance-payment deferral, and the Form 3115 approval requirement for adopting it.. The discounted package is income in full on the day the card clears.

The expense side moves separately. On the cash method a Schedule C filer deducts an ordinary and necessary business expense in the year it is paid 3Ref 3Internal Revenue Service (2025).Publication 334, Tax Guide for Small Business (For Individuals Who Use Schedule C).The ordinary and necessary test for a business expense and the cash-method rule that a Schedule C filer deducts an expense in the year it is paid, used here to show package income and its delivery costs falling in different tax years., and the room rent, supplies and hours that deliver those five spring visits are paid next year. Sell a package in one tax year and deliver most of it in the next, and the income and the cost of earning it land on different returns.

There is one narrow door on the accrual side, and it does not open far. An accrual-method business can elect to defer part of an advance payment, but the deferral stops at the following tax year: "you cannot postpone including any payment beyond that tax year" 2Ref 2Internal Revenue Service (2022).Publication 538 (Rev. January 2022) — Accounting Periods and Methods.The cash-method rule that income actually or constructively received during the tax year is included in gross income that year, the one-year ceiling on the accrual-method advance-payment deferral, and the Form 3115 approval requirement for adopting it.. Visits still unredeemed in year three do not extend it, and the method is not adopted by having unused visits sitting on a card. Changing to it means filing IRS Form 3115 for approval 2Ref 2Internal Revenue Service (2022).Publication 538 (Rev. January 2022) — Accounting Periods and Methods.The cash-method rule that income actually or constructively received during the tax year is included in gross income that year, the one-year ceiling on the accrual-method advance-payment deferral, and the Form 3115 approval requirement for adopting it..

What that leaves for the discount is specific. The full collected amount is taxable this year at the discounted price, the offsetting costs arrive later, and the money lands in one quarter instead of spreading across the months the care runs. Whether an entity election changes the shape of any of it is the s-corp math, and it belongs with whoever signs your return.

Redemption is the variable that sets the price

A package's real price is the collected amount divided by the visits the patient eventually takes, which the practice does not know on the day it sets the discount. Ten visits sold at fifteen percent off a $200 rate collects $1,700. A patient who uses seven of them paid about $243 a visit. A patient who uses all ten paid $170. The discount sets the range; redemption picks the number inside it.

The calendar decides whether the discount buys anything at all. A package that fills hours you would have sold at the posted rate is a markdown on demand you already had. That is caseload math. A package earns its discount when it converts an hour that would have gone empty, or closes the gap between visits enough to finish a course of care that would otherwise have stalled.

The mix inside the bundle moves the number too. One flat per-visit price averages encounters that are not equal in length or complexity, and nothing stops a patient from spending the whole bundle on the long ones. If the bundle can absorb what would bill as level 5 visits on the insured side, size the discount against the long end of the range.

A package and a membership fail differently. A package is a fixed quantity sold once, so its risk is redemption. A membership is a recurring charge, so its risk is churn arithmetic. A monthly retainer priced against panel size is a third instrument again, the DPC equation, and it is a different business to run.

When a discount stops being a price and becomes a plan

The National Association of Insurance Commissioners published a model act for this corner of state law in 2007, and it was written around a third party selling access to somebody else's providers. The model defines a discount medical plan organization as one that "contracts with providers, provider networks or other discount medical plan organizations to offer access to medical or ancillary services at a discount" 4Ref 4National Association of Insurance Commissioners (NAIC) (2007).Discount Medical Plan Organization Model Act.The model definition of a discount medical plan organization as a third party contracting with providers or provider networks, and the content a licensing or registration application calls for..

A solo practice discounting its own posted rate to its own patients is a different shape from that. But the model text draws no line saying so, and neither does the one state statute in this record. Florida's definition of a discount plan turns on the same plural: an arrangement that "provides access for plan members to providers of medical services and the right to receive medical services from those providers at a discount" 5Ref 5The Florida Legislature (2026).The 2026 Florida Statutes, Section 636.202 — Definitions (Chapter 636, Prepaid Limited Health Service Organizations and Discount Plan Organizations).Florida's own statutory definition of a discount plan, worded around member access to multiple providers, sharing the model definition's multi-provider framing.. The plural carries the argument. Nothing in either text decides it.

Where a state's version does reach an arrangement, the cost is a filing and an annual fee. Florida requires an entity operating as a discount plan organization to be licensed by its Office of Insurance Regulation, at $50 a year for the license and its renewal 6Ref 6The Florida Legislature (2026).The 2026 Florida Statutes, Section 636.204 — License Required (Chapter 636, Prepaid Limited Health Service Organizations and Discount Plan Organizations).Florida's requirement that an entity operating as a discount plan organization be licensed by its Office of Insurance Regulation, and the $50 annual license and renewal fee.. The application under the model framework is a real one, calling for a statement describing the applicant, its facilities, personnel and discounted services, a listing of the people who run it, and copies of provider contracts 4Ref 4National Association of Insurance Commissioners (NAIC) (2007).Discount Medical Plan Organization Model Act.The model definition of a discount medical plan organization as a third party contracting with providers or provider networks, and the content a licensing or registration application calls for..

The lookup is short. Search your own state's statutes for "discount medical plan organization" or "discount plan organization", and read the definition section next to the exemptions section. Look in the insurance code, not the practice act. States that adopted the model made their own choices inside it, down to whether the thing issued is a license or a certificate of registration, so a neighboring state's answer is not yours.

What has to be in writing before the card runs

For a self-pay patient, the written estimate is a federal requirement. The No Surprises Act rules require a good faith estimate of expected charges once an uninsured or self-pay individual schedules a service or asks what it costs, within a window the regulation counts in business days 7Ref 7Office of the Federal Register (Departments of HHS, Labor, and Treasury — No Surprises Act implementing rule) (2021).§ 149.610 Requirements for provision of good faith estimates of expected charges for uninsured (or self-pay) individuals; § 149.620 Requirements for the patient-provider dispute resolution process.The good faith estimate owed to an uninsured or self-pay individual on scheduling or on request, its business-day timing, and the $400 threshold that opens the federal patient-provider dispute resolution process.. A package is a scheduled service and a quoted price at the same time, so it triggers both halves at once.

The number that matters afterwards is $400. Where the billed charge runs at least $400 above the estimate, the patient can open the federal patient-provider dispute resolution process 7Ref 7Office of the Federal Register (Departments of HHS, Labor, and Treasury — No Surprises Act implementing rule) (2021).§ 149.610 Requirements for provision of good faith estimates of expected charges for uninsured (or self-pay) individuals; § 149.620 Requirements for the patient-provider dispute resolution process.The good faith estimate owed to an uninsured or self-pay individual on scheduling or on request, its business-day timing, and the $400 threshold that opens the federal patient-provider dispute resolution process.. A package is unusually exposed to that gap, because the estimate is written once and the care is delivered over months. Anything added later, a longer visit, a second course, a charge for a missed appointment, is measured against a document you wrote in a single afternoon.

The package agreement itself is convention, and the conventions worth borrowing are short:

• What the package includes, and what falls outside it (a longer visit, a form, a letter, an after-hours call).
• The expiration date, if there is one, and what becomes of visits left on it.
• The refund rule for a patient who stops partway through, and whether it is pro rata.
• Whether the package transfers to anyone else, and to whom.

The four numbers to have before you post a price

Four numbers decide whether a package is a discount or a donation, and three of them come from inside the practice. Write down the posted cash rate for the visit type in the bundle, the per-visit floor your annual overhead sets, the redemption rate you are willing to assume, and the share of the collected amount that leaves in tax this year. The discount is whatever survives all four.

Two questions belong on somebody else's desk. The tax share goes to whoever prepares the return, along with the question of whether the accrual election is available to you and what Form 3115 would cost to file. The state question goes to counsel when the lookup leaves doubt, and always in three cases: the package is marketed to people who are not yet your patients, it bundles somebody else's services alongside your own, or it is sold as a membership with a recurring charge.

Run the table at full redemption first. If the package still clears the floor when every visit is used, what is left to settle is the writing and the state, and both of those have answers you can look up.