On December 9, 2025, the IRS issued Notice 2026-5, outlining how the One Big Beautiful Bill Act (OBBBA), signed into law on July 4, 2025, expands access to health savings accounts (HSAs) by:
- Permanently allowing employees to access telehealth and remote care services before meeting their high-deductible health plan (HDHP) deductible, while keeping them eligible for HSA contributions;
- Allowing individuals in certain direct primary care (DPC) arrangements to contribute to HSAs and use those funds tax-free to pay periodic DPC fees; and
- Designating bronze and catastrophic Affordable Care Act (ACA) Exchange plans as HSA-compatible, even when they do not meet standard HDHP requirements.
Telehealth and Remote Care Services
To qualify for HSA contributions, employees must be enrolled in a high-deductible deductible health plan (HDHP) that does not pay benefits, other than preventive care, before the minimum deductible is met. In the past, telehealth programs that offered no- or low-cost care could disqualify individuals from HSA eligibility. Temporary COVID-19 relief allowed HDHPs to cover telehealth before the deductible without affecting HSA eligibility, but that relief ended with the 2024 plan year. The OBBBA has now permanently allowed HDHPs to cover telehealth and other remote care services before the deductible without jeopardizing HSA eligibility for plan years beginning after December 31, 2024.
IRS Notice 2026-5 also confirms that otherwise eligible individuals may contribute to an HSA for 2025 even if, before OBBBA was enacted, their HDHP covered telehealth or remote care before the minimum deductible, as long as the plan met all other HDHP requirements. This applies whether contributions are made before or after July 4, 2025.
The notice also further clarifies which services qualify as telehealth or remote care that may be covered pre-deductible, and explains that related in-person services, medical equipment, or drugs generally cannot be covered before the deductible under this exception.
DPC Arrangements
Effective January 1, 2026, the OBBBA expands HSA eligibility for individuals enrolled in direct primary care (DPC) arrangements. Otherwise, HSA-eligible individuals can contribute to an HSA if DPC monthly fees are at or below $150 for single coverage or $300 for family coverage (adjusted annually for inflation). DPC fees are treated as qualified medical expenses and may be paid with HSA funds.
A qualifying DPC arrangement is a subscription model in which members pay a fixed, periodic fee for access only to primary care services from primary care practitioners. It does not qualify if it bills separately for covered services or provides services beyond primary care. Fees may be billed for periods longer than a month (up to a year) if they are fixed, periodic, and do not exceed the monthly limit on an annualized basis (for 2026, up to $1,800 per year for single coverage).
Notice 2026-5 clarifies that an HDHP cannot pay DPC fees or provide DPC membership before the minimum deductible is met, other than for specifically allowed benefits (such as preventive care or telehealth). DPC fees also cannot be applied toward the HDHP deductible or out-of-pocket maximum.
DPC fees may be reimbursed from an HSA if they are not paid by the employer (including through pre-tax salary reductions under a Section 125 cafeteria plan). HSA funds can be used to reimburse substantiated DPC fees even if paid before the coverage period begins. However, any portion of DPC fees that exceeds the monthly limit ($150/$300 in 2026) can still be reimbursed from an HSA but will disqualify the individual from making HSA contributions during the period of that coverage.
Bronze and Catastrophic Plans
To expand HSA access in the individual market, the OBBBA treats all bronze and catastrophic plans available through an ACA Exchange as HSA-compatible HDHPs beginning Jan. 1, 2026. Bronze plans have the highest deductibles and lowest premiums among the four ACA levels, while catastrophic plans offer even lower premiums with very high deductibles. Notice 2026-5 confirms that an employer-sponsored HRA, such as an individual coverage HRA (ICHRA) or qualified small employer HRA (QSEHRA), may be used to purchase individual bronze or catastrophic coverage without affecting the plan’s HSA-compatible HDHP status. However, as a general rule, an HRA (including an ICHRA) may reimburse only premiums in order to remain a health plan that does not disqualify employees from HSA eligibility. Download the bulletin for more details.
