President Trump last week signed a budget bill that included the largest expansions to Health Savings Accounts, or HSAs, since they were created in 2003. Although the bill did not include all of the provisions proposed and passed by the House, it did include three significant changes that will make millions more Americans eligible to participate in HSAs.
One provision expands eligibility for HSAs to the approximately 7.5 million Americans covered by Bronze and Catastrophic health insurance plans sold to individuals on the state health insurance marketplaces beginning Jan. 1, 2026. Another provision removes a barrier to HSA eligibility for individuals and families that have a special relationship with their primary care doctor, known as a “direct primary care” arrangement. Starting Jan. 1, 2026, these individuals can start participating in HSAs – if they meet all other HSA requirements – and use their HSA funds tax-free to pay their doctor’s monthly fee.
The final provision reinstates a COVID-era benefit whereby HSA-qualified health insurance plans were permitted to cover telehealth services without paying their deductible first. The previous telehealth services benefit expired at the end of last year. Congress made the provision retroactive to the beginning of this year and made the change permanent.
