Recent HSA Rule Changes: What Employers Should Be Reviewing This Year
Last summer’s major tax and spending legislation, the One Big Beautiful Bill Act (OBBBA), made several permanent and employer‑friendly updates to health savings account (HSA) rules. As we move further into the year, this is an important time for employers to revisit plan design, employee communications, and compliance materials, especially with updated IRS HSA contribution limits expected soon.
Below is a practical refresher on what changed, why it matters, and how employers can take action.
Key HSA Rule Changes Employers Should Know
1. Telehealth coverage is now permanently HSA-compatible
Under prior rules, covering non‑preventive telehealth services before the deductible could jeopardize an employee’s HSA eligibility. Temporary relief had been extended several times since COVID but it was never permanent.
What changed:
The OBBBA permanently allows pre‑deductible telehealth and other remote care services to be offered under an HSA‑compatible high‑deductible health plan (HDHP), effective for plan years beginning January 1, 2025 and later. This means employers can continue offering low‑ or no‑cost telehealth without disqualifying employees from making HSA contributions.
Employer takeaway:
If your telehealth benefit was previously “temporary” or cautiously designed due to HSA rules, you may now be able to simplify plan design and communications.
2. Direct Primary Care is no longer disqualifying coverage
For years, employers and employees were interested in Direct Primary Care (DPC) but pairing it with HSAs was risky. Participation in a DPC arrangement could unintentionally make an employee ineligible to contribute to an HSA.
What changed:
Beginning in 2026, the One Big Beautiful Bill creates a clear distinction between insurance premiums and DPC:
- Certain qualified DPC arrangements are no longer treated as insurance
- Participation in qualifying DPC does not affect HSA eligibility
- HSA funds may be used to pay DPC fees, subject to strict requirements
To qualify, a DPC arrangement must:
- Provide only primary care services
- Charge a fixed periodic fee
- Comply with monthly fee limits ($150 individual / $300 family, indexed annually)
HSA Changes That Did NOT Make the Final Law
While the OBBBA ultimately expanded HSA access in targeted ways, several widely discussed proposals were not included in the final legislation:
- No HSA contributions after Medicare enrollment: Individuals enrolled in Medicare (including Part A only) are still prohibited from contributing to an HSA, even if they remain employed and covered by an HDHP.
- No major increase to HSA contribution limits: Annual contribution limits continue to follow existing inflation‑based adjustments rather than the larger increases proposed in early drafts.
- No broad expansion of premium eligibility: HSAs still generally cannot be used to pay health insurance premiums, including employer‑sponsored coverage, outside of long‑standing exceptions (e.g., COBRA, unemployment coverage, Medicare after age 65).
- No blanket wellness or fitness coverage: Proposals to allow HSAs to cover gym memberships or general wellness expenses without medical justification were removed.
Compliance Reminder: 2027 HSA Contribution Limits Coming Soon!
We are anticipating the updated 2027 HSA contribution limits to be released this month. Once the limits are released, we will communicate the updated limits to our clients and partners.
Final Thoughts
Between permanent telehealth flexibility, new opportunities with Direct Primary Care, and upcoming HSA limit announcements, now is a smart time for employers to revisit HSA strategy and employee education with compliance front and center.
If you have questions about how these changes impact your plans or communications, our team is here to help. Please contact your Client Account Representative with questions.