- On December 30, 2025
On December 9, 2025, the Internal Revenue Service released Notice 2026-5, which explains how recent federal legislation expands eligibility for health savings accounts (HSAs). The guidance reflects changes made by the One Big Beautiful Bill Act (OBBBA), signed into law by President Donald Trump on July 4, 2025.
The OBBBA broadens access to HSAs in several significant ways. Specifically, it:
- Makes permanent the ability for individuals to receive telehealth and remote care services before meeting their high deductible health plan (HDHP) deductible without losing HSA eligibility;
- Allows individuals enrolled in qualifying direct primary care (DPC) arrangements to both contribute to HSAs and use HSA funds on a tax-free basis to pay DPC membership fees; and
- Treats bronze-level and catastrophic health plans offered through the Affordable Care Act (ACA) marketplaces as HSA-compatible, even if they do not otherwise meet all HDHP requirements.
This summary outlines those changes and highlights the key clarifications included in IRS Notice 2026-5.
Telehealth and Remote Care Coverage
Under existing HSA rules, individuals generally cannot contribute to an HSA if they are covered by a health plan that pays for non-preventive services before the plan’s minimum deductible is met. In the past, access to no-cost or low-cost telehealth services often made individuals ineligible for HSAs.
During the COVID-19 public health emergency, temporary relief allowed HDHPs to cover telehealth services before the deductible without affecting HSA eligibility. That relief ended after the 2024 plan year. The OBBBA permanently reinstates and extends this flexibility, allowing HDHPs to cover telehealth and other remote care services before the deductible is satisfied for plan years beginning after December 31, 2024.
Notice 2026-5 confirms that individuals remain eligible to make HSA contributions for 2025 even if, before the law was enacted, they were enrolled in an HDHP that provided pre-deductible telehealth coverage, as long as the plan otherwise met HDHP standards. This applies regardless of when the HSA contribution is made in relation to the law’s enactment date.
The notice also:
- Clarifies which services qualify as telehealth or remote care for this purpose; and
- Explains that in-person care, medical equipment, and prescription drugs connected to telehealth services generally cannot be covered before the deductible under this exception.
Direct Primary Care Arrangements
Beginning January 1, 2026, the OBBBA expands HSA eligibility to individuals enrolled in qualifying DPC arrangements, provided the monthly fee does not exceed $150 for self-only coverage or $300 for family coverage. These limits will be indexed for inflation in future years.
A DPC arrangement is defined as a membership-based model in which individuals pay a fixed, recurring fee for access to primary care services delivered by primary care providers. The law also classifies DPC fees as eligible medical expenses, allowing them to be paid or reimbursed with HSA funds.
Notice 2026-5 clarifies which arrangements qualify as DPC arrangements. For example, a DPC arrangement does not include programs that:
- Charge a membership fee but bill separately for covered services through insurance or other means; or
- Provide services beyond primary care, regardless of whether participants actually use those additional services.
The guidance also explains that DPC fees may be billed in advance for periods longer than one month—up to one year—provided the total fee remains fixed and does not exceed the applicable monthly cap when annualized. For instance, in 2026, a qualifying arrangement could charge $1,800 annually, $900 for six months, or $450 for three months for individual coverage.
The notice further addresses how DPC arrangements interact with HDHP requirements. An HDHP generally does not cover primary care services by paying DPC fees or offering DPC memberships until the deductible is met, except in specific cases (such as preventive care or telehealth). Additionally, for individuals enrolled in both an HDHP and a DPC arrangement, DPC fees do not count toward the HDHP’s deductible or out-of-pocket maximum.
Regarding reimbursement from HSAs, Notice 2026-5 provides that:
- DPC fees cannot be reimbursed from an HSA if they are paid by an employer, including through pre-tax salary reductions under a cafeteria plan;
- HSA funds may be used to reimburse DPC fees before the coverage period begins, as long as the expense is substantiated correctly; and
- Fees above the monthly dollar limit may still be reimbursed from an HSA, but doing so will disqualify the individual from making HSA contributions during the period of enrollment.
Bronze and Catastrophic Exchange Plans
To increase HSA participation in the individual insurance market, the OBBBA classifies all bronze-level and catastrophic health plans offered through ACA marketplaces as HDHPs starting January 1, 2026. Bronze plans generally feature higher deductibles and lower premiums compared to other metal tiers, while catastrophic plans typically have even lower premiums paired with very high deductibles.
Notice 2026-5 explains that employer-funded health reimbursement arrangements (HRAs), including individual coverage HRAs (ICHRAs) and qualified small employer HRAs (QSEHRAs), may be used to purchase bronze or catastrophic marketplace coverage without jeopardizing the plan’s HSA-compatible status. However, to preserve HSA eligibility, such HRAs generally may reimburse only insurance premiums rather than other medical expenses.