Earlier this month, the IRS issued guidance on the health savings account (HSA) changes enacted as part of the One Big Beautiful Bill Act (OBBBA). While the guidance does not significantly alter the provisions announced when the law was passed in July, it does provide helpful details on how the new rules will be applied operationally.
A significant piece of the OBBBA made permanent the COVID-19 era telehealth safe harbor, which permitted individuals enrolled in high-deductible health plans (HDHPs) to receive telehealth and other remote care services before meeting their deductible, without losing eligibility to contribute to an HSA. This permanent extension of the safe harbor is effective for plan years beginning January 1, 2025. While plans may continue to pay for these services on a first-dollar basis, the new guidance clarifies that the safe harbor does not extend to in-person services, medical equipment, or drugs furnished in connection with telehealth or other remote care services. For example, a plan may cover a telehealth consultation with a provider before the deductible is met, but may not provide pre-deductible coverage for prescriptions that the provider may prescribe as part of the visit.
The guidance also clarifies how Direct Primary Care Service Arrangements (DPCSAs) interact with HSAs. Starting in 2026, individuals covered by certain DPCSAs can:
- Contribute to an HSA while enrolled in a DPCSA; and
- Use HSA funds tax-free to pay periodic membership fees for direct primary care services.
Lastly, the guidance provides that beginning January 1, 2026, bronze and catastrophic health plans, including those obtained through a health insurance exchange, will be treated as HSA-compatible, even if they don’t meet the traditional high-deductible requirements. Additionally, the guidance provides that bronze and catastrophic plans purchased through a health reimbursement arrangement, including individual coverage HRA (ICHRAs), will still be treated as an HDHP.
The IRS is accepting public comments on the guidance through March 6, 2026, so additional guidance may be forthcoming.
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