The One Big Beautiful Bill brings some of the biggest updates to Health Savings Accounts in years. Not every reform advocates wanted made the final cut, but the changes that did will have a real impact on employers, brokers, and anyone who uses an HSA as part of their healthcare strategy.
Telehealth and direct primary care: clearer rules
Two of the most common headaches are gone. Telehealth and direct primary care (DPC) now work alongside HSAs instead of against them.
- Telehealth: Employers can offer pre-deductible telehealth, even at a $0 copay, without disqualifying employees from contributing to an HSA. Congress allowed this temporarily during the pandemic, and the new law makes it permanent, retroactive to the 2025 plan year.
- Direct primary care: Employees in a DPC arrangement stay HSA-eligible, and in a real shift, HSA dollars can now cover the monthly DPC membership fee itself, as long as it doesn’t top $150 a month for one person or $300 a month for a family. This takes effect January 1, 2026.
Together, those two fixes remove the barriers employers kept running into when they weighed a telehealth or DPC strategy.
Expanding HSA access through the marketplace
Starting January 1, 2026, certain bronze and catastrophic marketplace plans count as HSA-compatible too. Historically most exchange coverage didn’t qualify, so this opens tax-free HSA saving to a new group: employees and individuals between jobs who choose those lower-cost plans.
What didn’t make the cut
As big as these updates are, several long-debated HSA reforms didn’t survive negotiations:
- The Medicare Part A barrier: People automatically enrolled in Part A, often just by turning 65, still can’t contribute to an HSA even if they’re working and otherwise eligible.
- Spousal catch-up contributions: Each spouse’s catch-up still has to go into a separate account, rather than both contributing to one HSA.
- Broader eligibility: Proposals to lower the minimum deductible or loosen the definition of an HSA-qualified plan didn’t make it in.
- Drug and OTC flexibility: Earlier drafts floated expanding what counts as a qualified HSA expense, but that language was dropped.
In short, it’s real progress, just not the full wish-list overhaul some were hoping for.
Bottom line
The One Big Beautiful Bill modernizes HSAs in ways that matter. Employers can build in $0 telehealth and direct primary care without jeopardizing eligibility, employees can spend HSA dollars on DPC memberships, and certain marketplace plans finally qualify. The IRS has already issued guidance confirming how the new rules work.
The bigger fixes, like the Medicare Part A barrier and simpler spousal catch-ups, will have to wait. Even so, this is a strong step, and it gives brokers and employers fresh reasons to revisit plan design, employee communication, and where HSAs fit in the overall benefits strategy.