New Guidance for OBBBA HSA Provisions

By Vita on December 15, 2025

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Overview

The IRS released Notice 2026-05 which provides guidance on changes to Health Savings Accounts (HSAs) that were enacted as part of the One Big Beautiful Bill Act (OBBBA). The guidance provides answers to common questions related to these changes.

Note that we have included a “Relevance” note for each section. The Telehealth section is relevant to most employers. The other two sections are relevant to employers only in limited circumstances (so most can skip reading those).

Lastly, we have included a link to the full text with all 20 questions at the bottom. In the interest of brevity, we have summarized only the key questions that apply to employers. The question numbering from the IRS Notice has been retained for reference.

Telehealth Services

One-Sentence Summary. The OBBBA made permanent the safe harbor for providing telehealth (and other remote care services) under HDHPs prior to reaching the statutory deductible.
Relevance. This provision is relevant for any employer offering an HDHP as a coverage option.
A Little More History. This provision was originally enacted on a temporary basis in 2020 as part of the CARES Act (in response to the COVID pandemic). Subsequent legislation extended this provision through taxable years beginning before January 1, 2025. This left plans without first dollar telehealth coverage in 2025. The OBBBA made the exception for first dollar telehealth coverage permanent and retroactively applied the provision for plan years beginning after December 31, 2024 (thus eliminating the gap for 2025).

	Questions Clarified	Answer
1.	Are 2025 HSA contributions made prior to the OBBBA passage (July 4, 2025) eligible?	Yes
2.	Which benefits are considered telehealth? Expanded answer: Includes services on the list of telehealth services payable by Medicare or otherwise defined in guidance provided by the Department of Health and Human Services (HHS).	Follows Medicare Definitions
3.	If in-person services, medical equipment, or drugs are furnished in connection with a telehealth, can they be considered a telehealth service?	No

Bronze and Catastrophic Plans Treated as HDHPs

One-Sentence Summary. Bronze and Catastrophic health plans purchased through an Exchange are considered HDHPs, thus individuals covered by these plans are eligible to make HSA contributions.
Relevance. This provision is relevant primarily for those with individual coverage. It is also relevant for employers who have adopted an ICHRA or QSEHRA strategy for health coverage.
A Little More History. Before the OBBBA was enacted, many bronze plans did not qualify as HDHPs because the plans’ out-of-pocket maximum exceeded the statutory limits for HDHPs or because they provided benefits that were not preventive care without a deductible. Similarly, catastrophic plans could not be HDHPs because they were required to provide three primary care visits before the minimum deductible was satisfied and to have an out-of-pocket maximum that exceeded the statutory limits for HDHPs. This provision of the OBBBA amended the definition of an HDHP to include Exchange-based Bronze and Catastrophic plans. It is effective for months beginning after December 31, 2025.

	Questions Clarified	Answer
4.	Will a bronze or catastrophic plan that is available as individual coverage fail to be treated as an HDHP because an employer-sponsored health reimbursement arrangement (HRA) such as an individual coverage HRA (ICHRA) or a qualified small employer HRA is used to purchase the coverage?	No
5.	Will bronze plans offered as Small Business Health Options Program (SHOP) coverage be treated as HDHPs?	No

Direct Primary Care

Two-Sentence Summary. Direct Primary Care arrangements are no longer considered disqualifying coverage when paired with an HDHP, thus preserving the ability to contribute to an HSA. Direct Primary Care expenses are also eligible for reimbursement under an HSA, subject to a limit of $150 per month (individual coverage) or $300 per month (family coverage).
Relevance. This provision is not directly relevant for employers who do not offer Direct Primary Care plans. However, it is relevant for employers who offer an HDHP AND sponsor a Direct Primary Care (DPC) and/or for employers who are considering offering a DPC plan nationally for employees. Otherwise, it is relevant only for individuals who are covered by an HDHP and separately purchase a Direct Primary Care plan.
A Little More Depth. A Direct Primary Care plan is defined as arrangement under which an individual is provided medical care provided by primary care practitioners, if the sole compensation for such care is a fixed periodic fee. Direct Primary Care Services include an array of services such as physical examinations, vaccinations, urgent care, laboratory testing, and the diagnosis and treatment of some sicknesses and injuries. The second provision is that DPCSAs do not include any arrangement if the fees exceed $150 per month (or $300 for a family of two or more). These limits are adjusted annually for inflation for taxable years after 2026. The provision relating to DPC plans applies to months beginning after December 31, 2025.

	Questions Clarified	Answer
6.	Does a DPCSA include an arrangement that provides certain healthcare items and services to individuals, pay a fixed periodic fee and are also billed separately for those items and services (through insurance or otherwise)?	No
7.	If an individual is enrolled in both a DPCSA and an HDHP, may the HDHP count fees paid by the individual for the individual’s membership in the DPCSA toward the annual deductible and out-of-pocket maximum for the HDHP?	No
8.	Are DPC plan fees treated as amounts paid for qualified medical expenses that may be reimbursed by an HSA if they were paid by an individual’s employer, including by salary reduction through a section 125 cafeteria plan? Expanded answer: Payments by the employer are not expenses of the HSA beneficiary (which is a requirement for qualified HSA reimbursements. The payments are compensation excluded from employees’ gross income.	No

References

IRS Notice 2026-5

New Guidance for OBBBA HSA Provisions

Overview

Telehealth Services

Bronze and Catastrophic Plans Treated as HDHPs

Direct Primary Care

References

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