July 9, 2025
With the passage of the One Big Beautiful Bill Act (OBBBA), signed into law on July 4, 2025, new rules for Health Savings Accounts (HSA) have been introduced, intended to increase HSA availability to more people.
To provide some background, under the current law (pre-OBBBA), individuals may contribute to a Health Savings Account if they have coverage under a qualified High-Deductible Health Plan (HDHP) and are not covered by any other health plan that is not a qualified HDHP but provides similar benefits.
Under prior law, Direct Primary Care (DPC) service arrangements - where individuals pay a fixed periodic fee to a primary care provider for services – were considered a form of health coverage by the IRS, disqualifying individuals from contributing to an HSA. Under the new law, DPC arrangements are now permitted alongside an HSA.
Another change in the law makes permanent the Telehealth coverage exception originally introduced by the Coronavirus Aid, Relief, and Economic Security Act (CARES Act). Normally, an HDHP requires individuals to pay out their deductible before the insurance covers any services. Under the CARES Act, HDHPs were temporarily allowed to provide telehealth services without requiring patients to first meet their deductible. The OBBBA now makes this exception permanent.
Additional changes are outlined in the table below, which compares (1) the current law under the TCJA, (2) what the law would have been without the OBBBA and after the TCJA provisions expired, and (3) the new law under the OBBBA.
|
HSA Rule |
Current Law (2025) |
Post TCJA (No New Law) |
New Law (OBBBA, Effective 2026) |
|
Eligibility with Affordable Care Act (ACA) Bronze/Catastrophic Plans |
Not eligible |
Not eligible |
Eligible |
|
Telehealth Coverage Before Deductible |
Temporarily allowed (through 2024) |
Disallowed |
Permanently allowed (effective 2025) |
|
Direct Primary Care (DPC) Eligibility |
Disqualifies HSA eligibility |
Disqualifies HSA eligibility |
Allowed (with some restrictions) |
|
Use of HSA for DPC Fees |
Not allowed |
Not allowed |
Allowed if monthly fee ≤ $150 (or $300 for families), adjusted for inflation |
Click here to return to Larson & Company's One Big Beautiful Bill Act summaries.