The Treasury Department and the Internal Revenue Service (IRS) have released new guidance that expands who can qualify for a Health Savings Account (HSA), giving millions more Americans a tax-free way to save for and pay medical expenses.
Driven by the One, Big, Beautiful Bill (OBBB), the update marks a significant shift for people who rely on high-deductible health plans (HDHPs), use direct primary care arrangements, and—now for the first time—those enrolled in Bronze and Catastrophic plans sold on or off Insurance Exchanges.
Together, these changes could substantially reshape how many Americans use tax advantages to manage out-of-pocket health care costs.
Key Changes in Notice 2026-05
In Notice 2026-05, issued Tuesday, the IRS and Treasury outlined several major updates to HSA eligibility and use:
- Telehealth and Remote Care
Americans may continue to access telehealth and other remote care services before meeting their HDHP deductible and still remain eligible to contribute to HSAs. Under the OBBB, this policy becomes permanent for plan years beginning on or after January 1, 2025. - Bronze and Catastrophic Plans
Starting January 1, 2026, Bronze and Catastrophic health plans—regardless of whether they are purchased on or off the federal exchange—will be treated as HDHPs for HSA purposes. This will open HSA participation to people who have historically been excluded under these plan designs. - Direct Primary Care (DPC)
As of January 1, 2026, individuals enrolled in qualifying direct primary care service arrangements will be allowed to contribute to HSAs and use HSA funds tax-free to pay DPC fees.
According to the IRS, these updates will enable many more Americans to access the “triple tax advantage” of HSAs: tax-deductible contributions, tax-free growth, and tax-free withdrawals for qualified medical expenses.
How Officials Are Framing the Changes
An IRS press release stated: “These changes expand HSA eligibility, which allows more people to save and to pay for health care costs through tax-free HSAs.”
An information page from HealthCare.gov explains: “As a result of the Working Families Tax Cuts legislation signed into law by President [Donald] Trump, more 2026 Marketplace plans—including all Bronze and Catastrophic health plans—now work with Health Savings Accounts to help you pay your share of costs for health care.”
What Comes Next
The IRS is accepting public comments on all aspects of Notice 2026-05 through March 6, 2026. Stakeholders—including consumers, medical providers, employers, and insurers—are encouraged to submit feedback via the Federal e-Rulemaking portal or by mail.
Notice 2026-05 is an early step in the broader implementation process, and additional guidance and adjustments are expected as regulators refine how the new rules will work in practice.
At the same time, the scheduled expiration of enhanced Affordable Care Act premium tax credits at the end of 2025 is intensifying pressure to find other ways to make coverage more affordable. Some lawmakers, including Republican Senator Josh Hawley of Missouri, are pushing for expanded tax deductions for health-related expenses as part of an ongoing debate over how far federal health care subsidies should go and who should benefit from them.
