The Internal Revenue Service has issued Notice 2026-5 which provides guidance in the form of Q&As on the changes to Health Savings Account (“HSA”) requirements under the One, Big, Beautiful Bill Act (“OBBBA”).
The OBBBA expands access to HSAs by making the following changes:
Telehealth and Remote Care Services. The OBBBA made permanent the ability to receive telehealth and other remote care services before meeting the high-deductible health plan (HDHP) deductible. This rule is effective for plan years beginning on or after January 1, 2025. A plan will not fail to be an HDHP solely because it offers telehealth benefits without a deductible for a service that, among other things, is included in the list of telehealth services payable by Medicare. (The list is published annually by the Department of Health and Human Services.)
Bronze and Catastrophic Plans. As of January 1, 2026, bronze and catastrophic plans available through an Exchange are considered HSA-compatible, regardless of whether the plans satisfy the general definition of an HDHP. Bronze and catastrophic plans do not have to be purchased through an Exchange to qualify for the new relief.
A bronze or catastrophic plan that is available as individual coverage will not fail to be an HDHP simply because an employer-sponsored Individual Coverage Health Reimbursement Arrangement is used to purchase the coverage.
Direct Primary Care Service Arrangements. A Direct Primary Care Service Arrangement (“DPCSA”) is an arrangement under which an individual is provided medical care consisting solely of primary care services provided by primary care practitioners, if the sole compensation for such care is a fixed periodic fee, and such care does not include: (1) procedures that require the use of general anesthesia, (2) prescription drugs other than vaccines, or (3) laboratory services not typically administered in an ambulatory primary care setting.
There is no specific limit on the amount of the fixed periodic fee as there is for purposes of determining whether a DPCSA is a health plan. Thus, fees for a DPCSA that do not satisfy the monthly dollar limit will be treated as medical expenses reimbursable from an HSA but will disqualify the covered individual from eligibility for making HSA contributions while the individual is enrolled.
Beginning January 1, 2026, an otherwise eligible individual enrolled in certain DPCSAs may contribute to an HSA. In addition, they may use their HSA funds tax-free to pay periodic DPCSA fees.
The new law provides that HSAs may be used to pay for this primary care up to $150 per month for individuals and $300 for families.
The IRS Notice is available at: https://www.irs.gov/pub/irs-drop/n-26-05.pdf