HSA Changes Make Millions of Americans Newly Eligible for a Triple Tax Benefit

Starting in 2026, millions more Americans will become eligible to open and contribute to health savings accounts, or HSAs, under three provisions in the One Big Beautiful Bill Act.

Established in the early 2000s, HSAs are tax-advantaged savings accounts that let people set aside money for medical expenses. HSAs have historically been limited largely to people enrolled in certain high-deductible health plans, or HDHPs. For 2026, that means a plan with a deductible of at least $1,700 for individuals or $3,400 for families, along with several other restrictions.

However, under the new law, three groups of people are now eligible for an HSA. Morningstar estimates new provisions could bring an additional 3 to 4 million Americans into HSAs: a significant increase for a market that already counts roughly 40 million accounts holding nearly $160 billion.

Unlike flexible spending accounts (FSAs), which generally require you to use the funds annually or lose them, HSA funds roll over year to year. Contributions are tax-deductible, the money grows tax-free and withdrawals for qualified health care costs aren’t taxed, meaning expanded access could be a game-changer for savers.

“There’s no 'use it or lose it' rule, and HSAs are portable if you change jobs,” Harrison Newman, vice president and employee benefits consultant at Corporate Synergies tells Money. “When used strategically, they can function like a stealth retirement account for health care, with unmatched tax benefits.”

Americans who now qualify for HSAs include those with:

Bronze and catastrophic health plans

Starting this year, anyone enrolled in a bronze or catastrophic health plan sold through the Affordable Care Act marketplace will qualify for an HSA.

While these plans often have high deductibles, most previously failed to meet the IRS’s strict HDHP criteria — particularly its rules limiting coverage of non-preventive care before the deductible is met.

But as of Jan. 1, people enrolled in one of these two plans can open and contribute to an HSA.

“Bronze and catastrophic plans usually come with high deductibles, so confirming HSA eligibility removes confusion and gives people a way to offset out-of-pocket costs,” says Newman. “For those on tight budgets, the ability to save pre-tax dollars and reduce taxable income can make health care more affordable.”

Direct primary care arrangements

Also effective Jan. 1, people using direct primary care (DPC) arrangements can now use HSA funds to pay for those services. In these subscription-based programs, patients pay a flat monthly fee to their doctor for primary care services like office visits, wellness exams and so on.

A 2023 survey by the American Academy of Family Physicians found that 9% of family doctors operated a DPC practice, up from 3% in 2022.

Previously, DPC arrangements were considered “other coverage” by the IRS, which prevented HSA holders from using their accounts to pay for them. That disqualification ends this year.

“The worst-case scenario is someone electing a high-deductible health plan thinking they’re HSA-eligible, only to find out later they’re disqualified because of DPC or another reason,” says Newman, adding that the rule change mostly clears up ambiguity.

As a result, people can confidently combine DPC with an HSA, gaining more control over health care spending without unexpected tax consequences.

Telehealth services

HDHPs can now permanently cover telehealth services before a deductible is met — while still maintaining HSA eligibility.

Previously, accessing telehealth before meeting the minimum deductible could disqualify someone from contributing to an HSA. Temporary waivers passed by Congress during the pandemic allowed HSA holders to previously access telehealth without losing eligibility, but those rules expired in 2024.

The new law makes this policy permanent retroactive to Jan. 1, 2025, ensuring that people can continue to use telehealth services without jeopardizing their HSA contributions.

All this means is that if your health plan wants to cover virtual doctor appointments at no cost to you (or with a small copay) before you've met your deductible, it is allowed to do so — and you can contribute to your HSA.

“It’s a big win for accessibility and cost savings,” says Newman. “This change removes a major barrier that previously forced people to choose between virtual care and HSA contributions — a huge misstep that slowed HSA growth.”

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