The short answer
For a single-program brand with an engineer on staff, Stripe Billing is a fine choice and the cheapest: 0.7% of billing volume with no monthly fee, smart retries and a customer portal included. Recurly and Chargebee earn their higher list prices when you run many plans, currencies and revenue-recognition rules, which few telehealth brands do. None of the three knows what a clinical approval is, when a pharmacy filled a prescription, or that a dose change should reprice a plan without a new checkout, so each needs code between it and your clinical workflow. A platform-native billing engine exists to be that code: it starts the subscription when the provider approves, follows the fill, and reprices on the dose change, because it is part of the same system as the intake and the portal.
That is the whole comparison in one paragraph. The tables below show the prices and the six special cases, and the honest note at the end says when we would still tell a founder to use Stripe Billing.
Published prices, September 22, 2026
| Stripe Billing | Recurly | Chargebee | Platform-native (Turbopills) | |
|---|---|---|---|---|
| List price | 0.7% of billing volume, no monthly fee; annual tiers from $620/mo (up to $100K) to $5,750/mo (up to $1M), 0.67% overage | Starter $249/mo plus 0.9% of billing volume (first $40K free each month); All-Access under 1% billed annually with a $1M minimum | Flow $0 plus 0.80%, or $99 plus 0.65%; Enterprise custom | Included in the platform fee; quoted per program |
| Card processing | 2.9% plus 30 cents with Stripe Payments; ACH 0.8% capped at $5 | Your gateway (20-plus supported) | Your gateway (40-plus supported) | Your own gateway accounts; multiple gateways with failover |
| Retries and dunning | Smart Retries, reminders, up to three recovery automations | One dunning campaign on Starter; intelligent churn tools on All-Access | Included | Automatic retries, reminders, one-click refunds |
| Customer portal | Yes | Hosted subscriber portal on All-Access | Yes | Patient portal with subscription, orders, refills and messaging in one place |
| Add-ons quoted | Usage billing via Metronome | Engage from $1,600/mo; RevRec from $850/mo | CPQ and RevRec custom | None |
| HIPAA statements on the pricing page | None | None | None | Platform operates as business associate; billing carries no medical content |
Sources: Stripe Billing pricing, Recurly pricing, Chargebee pricing. On HIPAA: payment processing itself sits under the law's financial-transaction exemption, so processors do not sign business associate agreements for it, and what matters is what you send them. Descriptors, plan names, metadata and receipt emails should carry the brand and the membership, not the condition or the drug.
The six things a telehealth subscription does differently
| Special case | What has to happen | Stripe Billing / Recurly / Chargebee | Platform-native |
|---|---|---|---|
| Approval-gated start | Card authorized at checkout, captured and the cycle started when a licensed provider approves; declined cases never charged | Possible with code: create the subscription in a paused or trialing state and activate it from your clinical system's webhook | Built in; the approval event starts billing |
| Fill-driven cadence | A 28-day pharmacy fill against a monthly charge drifts; refills need clinical sign-off | Your code reconciles fills and charges; billers only know dates | Billing, refill and order status share one record |
| Dose-driven price | Titration changes the drug cost; the plan reprices without a new checkout | Plan changes with proration, triggered by your code | Reprice on the provider's dose change |
| Pause for clinical reasons | Side effects, labs pending, a hold on a controlled substance after December 31 | Pause and resume via API from your code | Pause from the provider queue or the portal |
| Partial refund when a fill fails | Refund the drug component, keep the care fee | Manual or coded refunds per line item | One-click partial refund tied to the order |
| Restricted-category resilience | A second gateway ready when the first pauses approval; dispute ratio kept under Visa's 1.5% | Stripe is Stripe; Recurly and Chargebee route to multiple gateways with configuration | Multiple gateways with failover; dispute-prevention settings described in the VAMP post |
Every "possible with code" cell is a webhook, a state machine and a test suite. The first one is also the one that decides whether your checkout has the fact pattern in the FTC's July 29 complaint against Hims & Hers, which alleged charges at intake before any consultation; the checkout spec is the design answer, and a general biller will do it only if someone builds it.
Cost at 500 patients
Assume 500 patients paying $149 a month, so $74,500 of billing volume.
| Billing fee | Notes | |
|---|---|---|
| Stripe Billing | About $522 (0.7%), plus roughly $2,384 of card processing | Cheapest list price; all six special cases are your engineering |
| Recurly Starter | $249 plus 0.9% of the volume above $40,000, about $559, plus gateway fees | Dunning is one campaign on Starter |
| Chargebee Flow | About $596 at 0.80%, or $583 at $99 plus 0.65%, plus gateway fees | Strong plan modeling; no clinical awareness |
| Platform-native | Included in the platform fee, plus card processing on your gateway | The six cases are configuration |
The billing fee is not the cost. At this size the fee is a few hundred dollars a month on any option; the expensive line is the engineering that connects billing to clinical events, which the launch budget prices at $20,000 to $60,000 of contractor work for a stitched stack, plus the months it takes and the bugs that surface as disputes. That is the number to compare a platform fee against, not 0.7%.
When a general biller is the right answer
Use Stripe Billing when you have one program, an engineer who will own the approval webhook, and a plan to keep the stack for years. Use Recurly or Chargebee when you sell in several currencies, run dozens of plans, or need revenue recognition for an audit, which describes a funded company at scale rather than a founder-led brand. In both cases, build the approval-gated start first, before the marketing site, because it is the piece that protects the merchant account.
Use a platform-native engine when billing, intake, provider review, pharmacy and portal need to be one system, which is most cash-pay telehealth brands under a few thousand patients, and when the team does not want to own a billing state machine. That is what Turbopills' billing engine is: subscriptions, installments and one-time charges, on the founder's own gateway accounts with failover, starting on clinical approval, with retries, refunds and HSA payments handled in the same place as the order. We are in private beta and quote per program; the demo to ask for is a declined case, a failed renewal, a dose change and a partial refund, in that order.
FAQ
Which subscription billing software is best for telehealth? For a single program with an engineer, Stripe Billing at 0.7% of volume is the cheapest general option. Recurly and Chargebee suit multi-plan, multi-currency companies. A platform-native billing engine is the right choice when the subscription has to start on clinical approval, follow pharmacy fills and reprice on dose changes without custom code.
How much does Stripe Billing cost in 2026? 0.7% of billing volume pay-as-you-go with no monthly fee, or annual tiers from $620 a month (up to $100,000 of monthly volume) to $5,750 (up to $1 million), with 0.67% on additional volume. Card processing with Stripe Payments is 2.9% plus 30 cents per charge.
How much do Recurly and Chargebee cost? Recurly's Starter plan is $249 a month plus 0.9% of billing volume, with the first $40,000 of monthly billings included; its All-Access plan is under 1% billed annually with a $1 million volume minimum. Chargebee's Flow plan is $0 plus 0.80% of volume or $99 plus 0.65%; Enterprise is custom.
Can you bill a telehealth subscription before the provider approves treatment? You can, and the FTC's July 2026 complaint against Hims & Hers alleges exactly that as a deceptive practice; the company disputes it. The safer design authorizes the card at checkout and captures it, starting the cycle, only when a licensed provider approves. General billers support this with custom code; a platform-native engine does it by default.
Do payment processors sign HIPAA business associate agreements? Generally no, because payment processing falls under HIPAA's financial-transaction exemption. The brand is responsible for keeping medical content out of descriptors, plan names, metadata and receipts, and for the clinical system that holds the record.