OBBB Act: The 3 Changes Made to Health Savings Accounts (HSAs)
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What is an HSA? | Change #1: Telehealth is Now Permanent | Change #2: New Qualifying Plans | Change #3: Direct Primary Care Memberships | Bonus Change: Upgraded Dependent Care FSA Limits | How This Affects Your Tax Strategy | Why It Matters
Accounts such as HDHPs, FSAs, and HSAs were designed to help Americans save money on healthcare, but how to qualify was always unnecessarily complicated. That changed with the One Big Beautiful Bill Act, signed into law on July 4, 2025, rewriting the rules in a way that simplifies the qualification process, helping more Americans qualify and save meaningful amounts on healthcare.
Let’s discuss what changed, why it matters and how you can benefit.
What is an HSA?
A Health Savings Account (HSA) is a tax-advantaged account that lets you set aside money solely for medical expenses. There are three major tax benefits that really stand out:
- Contributions go in pre-tax
- Money grows tax-free
- Withdrawals for qualified medical expenses are tax-free
Unlike with a Flexible Spending Account (FSA), where unused funds are reset at the end of the year, your HSA balance rolls over year after year. If well-funded and correctly set up, your HSA can eventually function as a secondary retirement account.
The catch is that you can only contribute to an HSA if you’re enrolled in a qualifying High Deductible Health Plan (HDHP). Before the OBBB Act, the qualifications for an HDHP were narrow and not many people could qualify. After the act, due to the rewriting of some rules, it now includes many who previously were not eligible.
Change #1: Telehealth is Now a Permanent First-Dollar Benefit
During the COVID-19 pandemic, Congress temporarily allowed people enrolled in HDHPs to access telehealth and remote care services before meeting their deductible without losing their HSA eligibility. That relief kept expiring and getting renewed, finally expiring officially at the end of 2024.
The OBBBA made that telehealth exception permanent. The permanent extension is effective for plan years beginning January 1, 2025, meaning the gap between when the old relief expired and when the new law was signed is covered retroactively.
Your health plan can now cover telehealth visits with no deductible requirement, and you don’t lose your ability to contribute to your HSA because of it. For people managing chronic conditions or those who rely on virtual care as their primary form of healthcare access, this is a major win.
Change #2: New Qualifying Plans
As of January 1, 2026, bronze and catastrophic plans available through an Exchange are considered HSA-compatible, even if they don’t fit the general definition of an HDHP.
Why does that matter? Bronze plans typically carry the lowest monthly premiums on the ACA marketplace. Catastrophic plans are low-cost, worst-case-scenario insurance with high deductibles meant to protect people from exorbitant medical debt. Neither of these plan types previously guaranteed HSA eligibility, meaning people who chose affordability over total coverage lost access to one of the most powerful tax-saving tools available to them.
This change could increase the number of HSA-eligible individuals on the marketplace to 10 million, according to the White House. If you’re self-employed, a gig worker, or anyone who buys their own insurance, this act could introduce a new tool to your tax strategy.
*This provision only applies to individual healthcare coverage and doesn’t extend to SHOP or small and medium-sized business exchange purchases.
Change #3: Direct Primary Care Memberships
Direct Primary Care (DPC) is a healthcare model where patients pay a flat monthly fee directly to a primary care physician for:
- Unlimited visits
- Longer appointments
- No insurance middleman
This type of membership has been gaining popularity in the last couple of years, but the problem was the IRS treated DPC membership fees as a form of health coverage, which disqualified people from contributing to an HSA.
The OBBB Act, as of 2026, now treats DPC arrangements as health plans that do not disqualify you from contributing to an HSA. DPC service arrangements will also qualify as an HSA-eligible medical expense, limited to:
- $150 per month for individuals
- $300 per month for multiple covered individuals, indexed for inflation
This is a helpful change for the growing number of patients who use DPC to complement a high-deductible plan rather than a replacement for insurance.
Bonus Change: Upgraded Dependent Care FSA Limits
While this is not an HSA change, it’s worth mentioning alongside it. Dependent care FSAs are getting their first permanent increase in 40 years. Starting in 2026, the annual limit will rise from $5,000 to $7,500 per household, a $2,500 increase to the prior limit that had been stagnant since 1986. If you’re paying for childcare or caring for an aging parent, this is a new way to reduce tax that wasn’t possible before.
How This Affects Your Tax Strategy
Most tax changes are abstract until you see them applied to your own situation. The OBBB Act is different because the benefits are direct and quantifiable. Depending on your current health plan and household setup, you could be looking at thousands of dollars in new tax-advantaged opportunities that simply didn’t exist before 2025.
Here’s what that looks like in practice:
Telehealth Perk
More flexibility to use virtual care without losing your pre-tax HSA contributions.
Bronze/Catastrophic Plan
Potentially $4,400 in annual HSA contributions you previously weren’t eligible to make.
DPC Membership
Up to $1,800/year now counts as an HSA-eligible expense, reducing your taxable income.
Dependent Care FSA Bump
A $2,500 increase in tax-free dollars are available.
Why It Matters
If you’re currently enrolled in a bronze or catastrophic ACA plan, check with your plan administrator about your HSA eligibility for 2026 and start planning your contributions accordingly. If your employer offers a high-deductible plan with telehealth benefits, those benefits no longer put your HSA at risk.
The OBBB Act didn’t completely remodel the American healthcare system, but instead made changes to allow HSAs and FSAs to be available to millions of people who previously weren’t eligible. Look for these new opportunities made by the OBBB Act during your next open enrollment and make sure you don’t pass them up.
Sources:
IRS – 2026 contribution limits (401k, IRA)