This week: From virtual visits to direct primary care, HSAs are finally aligned with how people actually get care—and starting in 2026, more Marketplace shoppers can use them. Here’s what changed, what it means, and how to talk about it.
Note: Eric misspoke in this video. Individual consumers who purchase a bronze or catastrophic plan through the Marketplace will now be considered HSA eligible. Eric mistakenly said bronze or silver plans.
HSA Changes in the One Big Beautiful Bill
The One Big Beautiful Bill delivers the most significant set of Health Savings Account (HSA) changes in nearly two decades. The reforms give individuals and employers new flexibility, resolve longstanding uncertainties, and expand access to the triple tax advantages HSAs provide.
Not every idea made it into the final legislation, but this package is still a milestone for account holders, brokers, and plan sponsors alike.
Telehealth and Direct Primary Care: Longstanding Questions Resolved
For years, two issues created headaches for plan sponsors and confusion for employees: Telehealth and Direct Primary Care. Specifically, how do these benefits interact with Health Savings Accounts?
Telehealth
Before the pandemic, there was debate over whether a $0 telehealth benefit would disqualify someone from HSA eligibility. High-deductible health plans (HDHPs) generally must apply a deductible to non-preventive care, and it wasn’t clear if virtual visits counted.
During COVID, Congress basically answered that question (the answer was yes) by temporarily allowing pre-deductible telehealth at no cost — but only for two years. That safe harbor was later extended for an additional two years, through 2025.
Now, that fix is permanent. Plans can offer $0 telehealth visits or flat-dollar copays prior to the minimum HDHP deductible without jeopardizing HSA eligibility.
Direct Primary Care (DPC)
DPC is a membership model where patients pay a flat monthly fee to a primary care practice for routine services, longer visits, and same-day/virtual access—no insurance billing.
DPC memberships were once treated as disqualifying coverage because they provided access to care before the deductible.
The new law reverses that. Individuals remain HSA-eligible while enrolled in DPC arrangements, and HSA funds can now be used to pay membership fees.
Starting in 2026, members can use pre-tax dollars for these monthly costs — up to $150/month for individuals or $300/month for families, with inflation adjustments.
These changes bring HSA rules in line with how healthcare is actually delivered today, rather than locking them into an early-2000s framework.
Expanded Access Through the Marketplace
Another breakthrough: beginning in 2026, people who buy Marketplace Bronze or Catastrophic plans can contribute to an HSA — even if the plan doesn’t meet the traditional IRS definition of an HDHP.
That’s a major shift. Previously, only Bronze plans that were also HDHPs qualified. Now, a broader group of consumers — especially those seeking lower-cost coverage — can tap into the tax savings HSAs offer.
And many advocates would like to see this flexibility extended further — to off-exchange plans and even employer-sponsored coverage. That would give even more Americans the chance to pair affordable coverage with a long-term savings vehicle.
What Almost Made It In
The final bill is historic, but it could have gone even further. Provisions considered — but ultimately dropped — included:
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Allowing HSA funds to cover gym memberships and fitness expenses (up to $500 for an individual, $1,000 for a couple).
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Permitting spousal catch-up contributions into a single HSA account, rather than requiring separate accounts.
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Letting individuals continue HSA contributions while enrolled in Medicare Part A.
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Higher contribution limits based on income, with lower-income individuals allowed to contribute higher amounts.
These ideas enjoyed broad support but didn’t survive the final round of negotiations. Still, their inclusion in early drafts suggests they could return in future debates.
Looking Ahead: 2026 HSA and HDHP Limits
The IRS has already released the 2026 parameters:
| Category | Individual | Family |
|---|---|---|
| HSA Contribution Limit (2026) | $4,550 | $9,100 |
| HDHP Minimum Deductible | $1,700 | $3,400 |
| HDHP Maximum Out-of-Pocket | $9,450 | $18,900 |
| Non-HSA Plan Maximum OOP | $10,250 | $20,500 |
Notice that contribution limits — $4,550 for self-only and $9,100 for family coverage — are increasing again, while catch-up contributions for those age 55+ remain at $1,000.
Despite the “high deductible” label, HSA-qualified plans typically offer lower premiums and better catastrophic protection than non-HSA plans, with the added advantage of tax-free contributions, growth, and withdrawals.
Why This Matters
HSAs aren’t just for today’s bills—they’re the only account out there with a true triple tax advantage: tax-deductible contributions, tax-free growth, and tax-free withdrawals for qualified medical expenses. With permanent fixes for telehealth and DPC and new Marketplace flexibility, Congress has made HSAs easier to use—and easier to recommend—for millions of Americans.
The Bottom Line
The One Big Beautiful Bill doesn’t give HSA advocates everything they hoped for, but it does move HSAs firmly into the future:
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Telehealth is permanently HSA-compatible.
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Direct Primary Care is also HSA-compatible, and DPC memberships are eligible expenses.
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Marketplace Bronze and Catastrophic plan enrollees gain access beginning in 2026, even without an HDHP.
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And while some promising reforms were left on the cutting room floor, their day may soon come.
| Change | Status | Notes / Effective Date |
|---|---|---|
| Telehealth at $0 or flat copay without losing HSA eligibility | Passed |
Permanent policy; plans may offer pre-deductible telehealth at $0 or a flat dollar amount. |
| Direct Primary Care (DPC) no longer disqualifies HSA eligibility | Passed |
HSA funds may also be used for DPC membership fees (caps apply); begins 2026. |
| Marketplace Bronze & Catastrophic plan eligibility for HSAs | Passed |
Begins with the 2026 plan year; expands access beyond traditional HDHP designs. |
| Gym memberships / fitness expenses eligible from HSAs | Not included |
Proposed caps were discussed but removed before final passage. |
| Spousal catch-up contributions into a single HSA | Not included |
Couples still need separate HSAs for catch-up contributions. |
| Allow HSA contributions while enrolled in Medicare Part A | Not included |
Current rule remains: Part A enrollment blocks new HSA contributions. |
| Higher HSA contribution limits based on income | Not included |
Discussed in early drafts; ultimately removed. |
In short, this is not the end of the HSA reform story, but it is a significant chapter — one that brokers, employers, and individuals should pay attention to as they plan ahead. We’ve won a few battles in this one bill, but the fight isn’t over.