by section 1002, is amended by inserting or Medicare Advantage MSA after into a health savings account . (d) Effective date The amendments made by this section shall apply to taxable years beginning after December 31, 2018. 1004. Treatment of direct primary care service arrangement fees as medical expense (a) In general Section 223(c)(2)(C) of the Internal Revenue Code of 1986, as amended by the preceding provisions of this title, is amended by striking or at the end of clause (iii), by striking the period at the end of clause (iv) and inserting , or , and by adding at the end the following new clause: (v) any direct primary care service arrangement. . (b) Direct primary care service arrangement Section 223(c) of such Code, as amended by the preceding provisions of this title, is amended by redesignating paragraph (4) as paragraph (5) and by inserting after paragraph (3) the following new paragraph: (4) Direct primary care service arrangement For purposes of this paragraph— (A) In general The term direct primary care service arrangement means, with respect to any individual, an arrangement under which such individual is provided medical care (as defined in section 213(d)) consisting solely of primary care services (as defined in section 1833(x)(2)(B) of the Social Security Act) provided by primary care practitioners (as defined in section 1833(x)(2)(A) of the Social Security Act, determined without regard to clause (ii) thereof), if the sole compensation for such care is a fixed periodic fee. (B) Limitation With respect to any individual for any month, such term shall not include any arrangement if the aggregate fees for all direct primary care service arrangements (determined without regard to this subclause) with respect to such individual for such month exceed $150 (twice such dollar amount in the case of an individual with any direct primary care service arrangement (as so determined) that covers more than one individual). (C) Certain services specifically excluded from treatment as primary care services For