The One Big Beautiful Bill brings some of the most notable updates to Health Savings Accounts (HSAs) in years. While not every reform advocates wanted made it in, the changes will have a real impact on employers, brokers, and individuals who rely on HSAs as part of their healthcare strategy.
Telehealth and Direct Primary Care: Clearer, Better Rules
One of the biggest wins: telehealth and direct primary care (DPC) now play nicely with HSAs.
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Telehealth – Employers can now offer pre-deductible telehealth services, even with $0 copays, without disqualifying employees from contributing to an HSA. During the pandemic, Congress temporarily allowed this flexibility; the new bill makes it permanent.
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Direct Primary Care (DPC) – Similarly, employees enrolled in a DPC arrangement are still HSA-eligible. And in a big shift, HSA dollars can now be used to pay DPC membership fees. That means employees can use pre-tax funds to cover monthly membership costs, while still benefiting from the flexibility of an HSA.
Together, these changes remove two of the most common barriers employers faced when considering telehealth or DPC strategies.
Expanding HSA Access Through the Marketplace
The bill also opens the door for individuals buying certain bronze and catastrophic marketplace plans. Historically, most exchange-based coverage didn’t meet HSA requirements. Now, employees (and individuals between jobs) with these lower-cost options will have the ability to contribute to an HSA — expanding the pool of people who can take advantage of tax-free healthcare savings.
What Didn’t Make It Into the Bill
As big as these updates are, several long-debated HSA reforms didn’t survive negotiations, including:
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Medicare Part A rule – People automatically enrolled in Part A (often just by turning 65) are still barred from contributing to HSAs, even if they’re actively working and otherwise eligible.
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Spousal catch-up contributions – Catch-up contributions must still be deposited into a separate account, instead of allowing both spouses to contribute to the same HSA.
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Broader eligibility reforms – Proposals to lower the minimum deductible requirement or loosen the definition of HSA-qualified plans didn’t make it in.
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Over-the-counter insulin and prescription flexibility – Earlier drafts floated expanding what counts as a qualified HSA expense, but this language didn’t survive.
In other words: progress, but not the “wish list” overhaul some were hoping for.
Bottom Line
The One Big Beautiful Bill modernizes HSAs in meaningful ways. Employers now have the freedom to integrate $0 copay telehealth and direct primary care without jeopardizing eligibility, employees can use HSA dollars for DPC memberships, and certain marketplace plans finally qualify.
While bigger reforms — like fixing the Medicare Part A barrier or simplifying spousal catch-ups — will have to wait, this package is a strong step forward. For brokers and employers, these changes create new opportunities to rethink plan design, employee communication, and how HSAs fit into the benefits strategy.