HSA Eligibility Expands to Millions of Americans by 2026
Starting in 2026, millions more Americans will be eligible to open and contribute to health savings accounts, or HSAs, under three provisions in the Big One Good Bill.
Founded in the early 2000s, HSAs are tax-advantaged savings accounts that allow people to set aside money for medical expenses. HSAs have historically been largely limited to people enrolled in certain high-deductible health plans, or HDHPs. In 2026, that means a plan with a deductible of at least $1,700 for individuals or $3,400 for families, along with several other limits.
However, under the new law, three groups of people are now eligible to receive an HSA. Morningstar estimates that the new provisions could bring 3 to 4 million more Americans into HSAs: a significant expansion of a market that already has about 40 million accounts holding about $160 billion.
Unlike variable spending accounts (FSAs), which typically require you to spend the funds annually or lose them, HSA funds roll over from year to year. Contributions are tax-deductible, capital grows tax-free and withdrawals for qualified health care expenses are tax-free, meaning expanded access could be a game-changer for savers.
“There’s no ‘use it or lose it’ rule, and HSAs are portable when you change jobs,” Harrison Newman, vice president and employee benefits consultant at Corporate Synergies told Money. “Used wisely, they can serve as a private health care retirement account, with unmatched tax benefits.”
Americans who are now eligible for HSAs include those who:
Copper and catastrophic health systems
Starting this year, anyone enrolled in a copper or catastrophic health plan sold through the Affordable Care Act marketplace will be eligible to receive an HSA.
Although these plans often have high deductibles, most of the former failed to meet the IRS’s strict HDHP criteria — specifically its rules that limit non-preventive care coverage before the deductible is met.
But since Jan. 1, people enrolled in one of these two plans can open and contribute to an HSA.
“Copper and disaster plans often come with high deductibles, so verifying HSA eligibility eliminates confusion and gives people a way to reduce out-of-pocket costs,” Newman said. “For those on a tight budget, the power to save pre-tax dollars and reduce taxable income can make health care more affordable.”
Primary care arrangements are straightforward
And starting Jan. 1, people who use primary care plans (DPC) can now use HSA funds to pay for those services. In these subscription-based plans, patients pay a low monthly fee to their doctor for basic care services such as office visits, health exams and more.
A 2023 study by the American Academy of Family Physicians found that 9% of family physicians used a DPC practice, up from 3% in 2022.
Previously, DPC plans were considered “other items” by the IRS, which prevented HSA owners from using their accounts to pay for them. That waiver expires this year.
“The worst case scenario is someone who chooses a premium health plan thinking they qualify for an HSA, then later finds out they don’t because of DPC or some other reason,” Newman said, adding that the rule change largely clears up the ambiguity.
As a result, individuals can confidently combine a DPC with an HSA, gaining more control over health care spending without the unexpected tax consequences.
Health services
HDHPs can now indefinitely cover health services before the deductible is met — while still maintaining HSA eligibility.
Previously, accessing telehealth before meeting the minimum deductible would disqualify an individual from contributing to an HSA. A temporary waiver passed by Congress during the crisis allowed HSA holders to access telehealth earlier without losing eligibility, but those rules expire in 2024.
The new law makes this policy retroactive until Jan. 1, 2025, to ensure that people can continue to use health services without jeopardizing their HSA contributions.
All of this means that if your health plan wants to cover doctor appointments at no cost to you (or with a small copay) before you meet your deductible, it’s allowed to do so — and you can contribute to your HSA.
“It’s a huge win for affordability and savings,” Newman said. “This change removes a major barrier that forced people to choose between physical care and HSA contributions — a major mistake that has slowed HSA growth.”
More from Mali:
This Common HSA Mistake Can Cost You Thousands of Dollars
What is a Life Savings Account?
This Little-Used HSA Perk Can Bigger Your Savings
