As of November 2026, Spruce Health's Basic plan is $24 per user a month and Communicator is $49 per user a month, both month to month by default and both with the BAA included. The catch is not HIPAA, which Spruce handles well. It is that every staff member pays the patient-communication rate even if they only need internal chat, plus taxes, telecom fees and a one-time $19.50 SMS registration. Prices change, so verify on sprucehealth.com.
Every plan and price
Spruce is a patient-communication platform: HIPAA phone lines with two-way texting and voicemail transcription, secure patient messaging, video visits, e-fax, and team messaging with task assignment and a shared inbox. It sells to solo practitioners and small to mid-size practices, with iOS, Android, web and Mac apps. Internal staff chat is one feature among many, which shapes the price.
| Plan | Price | Unit | Billing | What it includes |
|---|---|---|---|---|
| Basic | $24 a month (does not include taxes or fees) | Per user | Month to month by default | HIPAA BAA, phone, text, video, fax, team chat, shared inbox, auto-replies, AI voicemail transcription |
| Communicator | $49 a month (plus taxes and fees) | Per user | Month to month by default | Everything in Basic plus IVR call flows, urgent escalation and after-hours triage, integrations and API access, VoIP phone service, AI transcription and summaries; labeled 'Best value' |
| Free trial | $0 for 14 days, no credit card | Per organization | n/a | SMS texting excluded from the trial |
| Extra fees | $19.50 one-time to enable outbound SMS; pass-through taxes and telecom fees; possible onboarding fees or an annual commitment for larger practices; SSO add-on price not shown | Various | n/a |
The fine print
- Both prices carry an asterisk: 'does not include taxes or fees'. Pass-through taxes and telecom fees have applied since November 1, 2025.
- Sending texts to patients requires a paid plan plus a one-time $19.50 registration to enable outbound SMS.
- All users in an organization must be on the same plan, so you cannot put two people on Communicator and the rest on Basic.
- API access is on Communicator only, at $49 per user.
- Larger practices may be asked for an annual commitment and onboarding fees; the page does not define 'larger'.
- SSO is an add-on with no price shown.
What a 5-person and a 15-person practice would pay
| Team | Plan | Monthly | Per year | Plus |
|---|---|---|---|---|
| 5 people | Basic | $120 | $1,440 | Taxes, telecom fees, $19.50 once for SMS |
| 5 people | Communicator | $245 | $2,940 | Same extras |
| 15 people | Basic | $360 | $4,320 | Same extras; possibly an annual commitment |
| 15 people | Communicator | $735 | $8,820 | Same extras; possibly onboarding fees |
The seat count is the lever. Because every user is billed at the same rate, the real question is how many people in the practice need a phone line, patient texting and fax. A front desk of two and a nurse who returns calls might be three seats. The other eight people, who only need to tell each other that room 2 is ready, are paying $24 a month each for a phone system they never answer.
HIPAA and the BAA: what it costs or requires
A BAA, or Business Associate Agreement, is the contract HIPAA requires before a vendor may hold protected health information (PHI), meaning anything that identifies a patient and relates to their care. Spruce charges nothing extra for it. The Basic plan card lists 'HIPAA BAA', and the FAQ says the BAA applies to all Spruce trials and paid plans; you agree to it electronically when you create an organization. The homepage shows HIPAA, HITRUST and SOC 2 badges. Spruce's help-center article on the BAA was not readable during our research, so these facts come from the pricing page and homepage.
How Yodl's flat price compares
This is not a like-for-like comparison, and we will not pretend it is. Yodl is staff-to-staff chat: channels, threads, direct messages, files, search, audit export and retention, with a signed BAA on the $10 plan. It has no phone lines, no patient texting, no fax and no video. Spruce is the patient line. The honest comparison is between paying Spruce for everyone and paying Spruce for the people who need it.
| Setup | Monthly cost | What you get |
|---|---|---|
| 15 people, all on Spruce Basic | $360 plus taxes and fees | Patient communication and team chat for everyone |
| 4 Spruce Basic seats plus Yodl for 15 | $96 plus taxes and fees, plus $30 | Patient communication for the four who use it; BAA-covered chat for all 15 |
| 5 people, all on Spruce Basic | $120 plus taxes and fees | Everything, for a small team that all work the phones |
| 5 people on Yodl only | $10 | Staff chat with a BAA; no patient line |
Pick Spruce if the practice needs a HIPAA phone line, patient texting, fax or video, or if every staff member genuinely works patient communication. Pick Yodl for the internal half, at $10 a month for 5 people with a signed BAA, on the pricing page. The side-by-side is at Yodl vs Spruce Health.
Spruce's price is fair for what it does and the BAA is included, but it is a per-user patient-communication bill. Pay it for the people who talk to patients and give the rest a flat-price staff chat.
Frequently asked questions
Does Spruce charge extra for the BAA?
No. The BAA is included on all Spruce trials and paid plans, and you agree to it electronically when you create your organization.
Is there a free Spruce plan?
No. There is a 14-day free trial with no credit card required, and SMS texting is excluded from the trial.
Can I mix Basic and Communicator seats?
No. All users in an organization must be on the same plan.
What fees come on top of the per-user price?
Taxes and pass-through telecom fees, a one-time $19.50 charge to enable outbound SMS, possible onboarding fees or an annual commitment for larger practices, and an SSO add-on with no published price.
Does Spruce include internal team chat?
Yes. Team messaging with task assignment and a shared team inbox is included on Basic. The question is whether every staff member needs a $24 seat to use it.