Therapists, counselors, and small clinics that email patients about their care often choose between Hushmail and Paubox. Both sign a business associate agreement (BAA), the contract HIPAA requires from a vendor that handles patient information. Hushmail gives a practice its own secure webmail with intake forms, and Paubox encrypts the mail a practice sends from Google Workspace or Microsoft 365.
Solo and small-group therapists, counselors, and psychologists who need HIPAA email plus intake forms with a BAA
Health systems that need high-volume transactional patient email APIs into an EHR
Clinics, health plans, and digital health vendors that need HIPAA-compliant email without forcing recipients through a portal
Buyers that only need patient SMS or EHR inbox messaging with no email encryption requirement
| Axis | Hushmail | Paubox |
|---|---|---|
| Keeping your current Gmail or Outlook account | Staff send from Hushmail webmail or a custom domain set up in Hushmail. | Stronger Staff keep sending from their Gmail or Outlook accounts, and Paubox encrypts each message on the way out. |
| What the patient sees | Patients may be sent to a private message center to read and reply, which surprises some of them. | Stronger The patient reads the message in their normal inbox with no portal and no password, which Paubox scores at 7.7. |
| Intake forms and e-signatures | Similar Secure intake forms with e-signatures come with Hushmail for Healthcare plans. |
Similar Paubox Forms, with e-signatures, comes free with paid Paubox Email Suite plans. |
| Setup effort | Similar A small practice can move its patient email off consumer Gmail and publish its first forms within about two weeks. |
Similar Setup is usually a change to how mail is routed, and someone has to own the DNS settings and the BAA paperwork. |
| Knowing what you will pay | Healthcare plan prices are listed on hushmail.com and depend on mailbox count, forms, and archive needs. | Stronger Starter plans are listed on paubox.com, and enterprise modules are quoted. |
| Larger senders and integrations | Hushmail trails on high-volume email sent from an EHR or CRM, and it cannot encrypt an existing enterprise Outlook account in place. | Stronger Paubox serves clinics, health plans, and digital health vendors with many senders, and it prices by mailbox or send volume. |
| Fit for a solo therapy practice | Stronger Hushmail for Healthcare is built around solo and small-group therapists, counselors, and psychologists. |
Paubox is aimed at clinics and digital health teams that send patient information from shared business mail. |
“Hushmail for Healthcare. Cheapest and easiest, roughly $11/mo, they sign a BAA, has a secure form feature that is nice for intake. ... Paubox. About $29/user/mo. Nicer because encryption is automatic on the recipient side, no portal login. If you send anything sensitive to referral sources, this is worth it.”
Ok_Intention_4136 · r/therapists · · source
“I’ve loved hushmail. It’s cheaper and they have good customer service”
ShartiesBigDay · r/therapists · · source
“it works in the background so you don't have to click any buttons or use a portal. the patient just gets the email like normal. it’s a bit pricier but the ux for the patient is basically unbeatable.”
Cautious-Poem8667 · r/healthIT · · source
Hushmail is for a solo or small-group therapy practice that wants one low-cost place for secure email and intake forms, and does not mind some patients signing in to a message center to read replies. Paubox is for a clinic or digital health team that wants staff to keep sending from Gmail or Outlook while every message is encrypted, so patients read it in their own inbox.
Walk away from Hushmail if your staff must stay in an existing Google Workspace or Microsoft 365 account. Walk away from Paubox if nobody can own the mail-routing change. Walk away from both if what you need is patient texting or messaging inside an EHR portal.