HSA - O'Connell Law Group

New HSA Rules and Opportunities in 2026

Health Savings Accounts (HSAs) have long been one of the smartest ways to save for medical expenses—but recent changes make them even more powerful. With expanded eligibility, new flexibility for direct primary care and telehealth, and improved options for marketplace plans, HSAs can now play a bigger role in both your healthcare and financial planning. Here’s what you need to know as we head into 2026.

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If you’ve ever wondered how to make your health care dollars go further, you’re not alone. Health Savings Accounts (HSAs) have always been a smart way to save up for medical costs, both now and years down the road. The best part? HSAs come with a “triple treat” of tax benefits: you get a tax break going in (thanks to deductions or pretax employer contributions), your money grows without pesky yearly taxes, and you can spend it tax-free on qualified health expenses whenever you need.

And here’s something not everyone knows: once you hit 65, your HSA gets even more flexible! You can use it to pay for Medicare premiums and other health care bills—still tax-free. It’s like getting rewarded for saving up for your health!

Further, the One Big Beautiful Bill Act (OBBBA), has significantly expanded access to Health Savings Accounts by modifying eligibility rules. Let’s dive into all of this!

HSAs: Why Everyone’s Talking About Them

Let’s talk about why these accounts are so handy. Anyone with an eligible high-deductible health plan can open and contribute to an HSA. Your contributions lower your taxable income, your savings grow quietly in the background, and when you have medical expenses, you can use your HSA funds without worrying about taxes. It’s a win-win-win.

What’s New for HSAs in 2026?

Big changes are coming, thanks to OBBBA and they’re mostly for the better. Here’s your friendly breakdown:

• Direct Primary Care Payments: Starting January 1, 2026, you can take out up to $150 a month (or $300 for couples) from your HSA—tax-free—to pay for direct primary care. That’s the type of doctor’s arrangement where you pay a regular membership fee, and your doctor is just a phone call or text away. Pretty convenient, right?

• Eligibility Made Simple: If you join a direct primary care arrangement and have a qualifying high-deductible health plan, you’re still eligible to put money in your HSA. Not all concierge-style practices count, though, so make sure yours fits the bill.

• Telehealth Gets a Boost: Remember during the pandemic when you could get telehealth visits with just a small co-payment, even before hitting your deductible? That perk is here to stay! Starting retroactively from January 2025, telehealth services are permanently exempt from deductible requirements for HSA-qualified plans.

Marketplace Plans Get More HSA-Friendly

If you buy insurance on the Affordable Care Act marketplace, good news: starting in 2026, bronze and catastrophic plans will automatically be HSA-qualified. That means you can pair your coverage with an HSA and get those tax-free savings for health expenses.

Combining Care and Coverage: Your HSA Can Do More

Roy Ramthun, founder of HSA Consulting Services, calls the combo of direct primary care and an HSA-qualified bronze plan a potential “win-win.” You can use direct primary care for day-to-day doctor visits, rely on your bronze plan for big medical events, and use your HSA to pay those monthly care fees without worrying about taxes.

Medicare and Your HSA: What to Watch Out For

It’s important to know that you can’t contribute to an HSA once you enroll in Medicare Part A or Part B. An earlier version of the law tried to change that, but it didn’t make the cut. So, if you (or your spouse) are still working and covered by an employer plan with 20+ employees, you can wait on signing up for Medicare. Just remember: once that coverage ends, you need to sign up for Part A and Part B within eight months to dodge a lifetime late-enrollment penalty for Part B. Also, if you sign up for Part A after 65, coverage can reach backward up to six months, so keep that in mind when figuring out how much you can still contribute to your HSA.

Final Thoughts

With these updates, HSAs are more flexible and powerful than ever. Take a look at your current health plan, see if you’re eligible, and start thinking about how your HSA could help you pay for direct care, telehealth visits, and regular medical needs. And if you’re approaching Medicare age, plan ahead so you don’t miss out on any contributions. By staying curious and informed, you’ll make your HSA a key part of your health and financial toolkit—for years to come!

Remember, we are here to help. If you have any questions, feel free to call us at 508-202-1818

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