The U.S. House of Representatives has passed the reconciliation bill – the One Big Beautiful Bill Act. The bill, which had previously passed the Senate, now heads to President Trump for his signature. The bill was subject to intense negotiation and significant change from the initial House-passed version as it worked through the Senate process.

HSA Provisions

In the end, the bill includes three provisions that expand access to Health Savings Accounts (HSAs):

Any Bronze or Catastrophic plan offered in the individual market on a state insurance exchange under the Affordable Care Act (ACA) would be considered “HSA-qualified” coverage. Currently, because of technicalities, the vast majority of such plans are not HSA compatible, despite the high cost-sharing exposure that consumers covered by them face. Given that 7.3 million Americans (including dependents) are covered by these plans in 2025, this represents the most significant expansion of HSA access in the bill. The change is effective beginning January 1, 2026.
HSA funds could be used tax free to pay periodic fees for direct primary care (DPC) arrangements. The provision also clarifies that DPC arrangements are not considered a separate health plan that would otherwise disqualify an individual from HSA eligibility. These provisions apply only to DPC arrangements with a monthly fee of $150 or less ($300 if the arrangement covers more than one individual). According to the DPC Coalition, over 300,000 Americans are covered by these arrangements, and their popularity, as well as the number of physicians converting to that model, is growing. Under current law, anyone enrolled in DPC is not eligible to contribute to an HSA, although they may be enrolled in an HSA-qualified insurance plan. The change is effective beginning January 1, 2026.
The bill restores the safe harbor for pre-deductible telemedicine coverage and makes it permanent. This allows HSA-qualified high deductible health plans (HDHPs) to offer this coverage. The employer community has been advocating for this restoration. This change is retroactive to plan years beginning after December 31, 2024.

The HSA provisions of the bill serve as a powerful indicator of support for a solution that already benefits tens of millions of Americans and that has proven effective in helping them to confront and better manage the challenge of ever-increasing healthcare expenses.

Taken together, these provisions represent the most consequential expansion of Health Savings Accounts since they were created over 21 years ago. The provisions also provide additional flexibility in plan design, building on the 2019 regulatory guidance that allows for pre-deductible coverage of certain chronic condition treatments in HSA-compatible plans. This is a significant loosening of the tight restrictions on HSA plan design in the original 2003 statute, and hopefully sets the stage for future reforms to allow further flexibility.

Source: WEX Inc.