We are just three months into 2026 but, when it comes to health care, it feels like it’s been three years. There have been a lot of changes, uncertainties, and proposals to try to fix the unsustainable path the system is on. In the midst of it all, it’s possible you might have missed the positive changes made to Health Savings Accounts (HSAs) that are giving you more control over your healthcare budget.
HSAs are tax-advantaged savings accounts that allow you to save money for your medical expenses. Previously, these were only available for those who had High-Deductible Health Plans (HDHPs), which offer lower monthly premiums but a higher deductible before your insurance starts to pay for some or all of your expenses. An HSA is a great tool to help pay for out-of-pocket medical expenses before meeting your deductible, but only 2% of enrollees on the ACA marketplace chose HSA-eligible plans before the rules changed.
On January 1st, a few changes from the One Big Beautiful Bill (OBBB) went into effect that expanded access and the usability of HSAs that you can take advantage of, so let’s go over what’s new.
Bronze and Catastrophic Plans are HSA Eligible
As previously mentioned, only certain plans qualified as a HDHP and would be eligible for an HSA. Now, Bronze or Catastrophic plans are automatically classified as HDHPs, making those eligible for HSAs as well. There are 7.27 million people enrolled in Bronze plans, and 54,000 in Catastrophic plans. But there is more. Catastrophic plans are available to people who are under age 30 or who qualify for a hardship exemption. That hardship exemption has now been expanded to anyone who does not qualify for tax credits or extra savings due to their income. So, check to see if you could qualify to open an HSA and do so if you can!
Use HSAs for Direct Primary Care
Direct Primary Care (DPC) is an insurance-free model of delivering primary care services. Patients pay a monthly fee, typically around $50–$150, which includes unlimited same- or next-day appointments with no additional copay, 24/7 direct communication with their doctor, and many of the services provided during appointments, from treating a cold to minor procedures. DPC clinics provide additional labs and tests at wholesale prices and may include other perks like direct prescription medications or more specialized services. These are a great option for patients who want to focus on prevention or have more personalized management of their care.
DPC used to be considered “other health coverage” under the IRS. This meant that any employers or individuals who participated in a DPC arrangement were disqualified from making HSA contributions. But now, DPC has been defined as a “non-insurance service arrangement,” making it fully compatible with HSAs. Funds can now be used to pay for DPC membership fees, up to $150 a month for individuals and $300 for families. Employers are also able to offer DPC benefits alongside an HDHP. Having both is recommended because DPC does not cover emergencies or hospital stays. To learn more about DPC and see if there is a clinic near you, visit mapper.dpcfrontier.com.
Telehealth is Now HSA-Compatible
When the rules for HDHPs and HSAs were written in 2003, telehealth did not exist the way we use it today. It didn’t quite fit into the rules, and was considered a non-preventative service that HDHPs could not cover until the deductible was met. Also, some telehealth providers were considered “other health coverage,” which would put HSA eligibility at risk. While no rules prevented telehealth usage for those with HDHPs and HSAs, it was a confusing landscape that led some insurers, businesses, and individuals to avoid it altogether.
The CARES Act in 2020 created a “safe harbor” that allowed HDHPs to cover telehealth visits before the deductible was met, and contract with telehealth providers to offer those services without risking HSA eligibility. This expired on January 1st, 2025, but the OBBB made it permanent for any plans that began on that same date. So if your current health insurance plan began in 2025, you can be certain that using telehealth will not risk your HSA eligibility.
Take Advantage!
These changes made to HSAs won’t fix everything, but they are real progress that gives you more freedom to take control of your health care costs. Expanded HSA eligibility, DPC compatibility, and permanent telehealth flexibility aren’t just policy tweaks. They’re building blocks for a more affordable, personalized, and patient‑driven healthcare experience. The more people understand and utilize these changes, the easier it will be to move our health care system in a direction that works better for everyone. So stay informed and make the most of the tools now at your disposal.