Key changes to HSAs and (potentially) HRAs in 2026 and beyond

Recent federal actions have brought significant changes to employee benefit plans, notably Health Savings Account (HSA) contribution rules and Health Reimbursement Arrangements (HRAs).

IRS Notice 2026-05

On December 9, 2025, the IRS issued guidance (IRS Notice 2026-05)¹ that clarified provisions of the One Big Beautiful Bill Act (OBBBA) that are noteworthy as HealthEquity’s members and clients plan for 2026.

By way of background, the OBBBA, enacted in July 2025, introduced several changes affecting HSAs, including a permanent safe harbor for pre-deductible telehealth and remote care, the designation of Affordable Care Act (ACA) Exchange bronze and catastrophic plans as HSA-compatible, and clarification that qualifying Direct Primary Care Service Arrangements (DPCSAs) do not disqualify individuals from HSA eligibility. The following sections address how this guidance affects HSA eligibility, plan design considerations, and reimbursement treatment.

Telehealth and remote care services

Individuals enrolled in an HSA-compatible High-Deductible Health Plan (HDHP) may contribute to their HSAs for 2025 if their HDHPs provided pre-deductible telehealth or remote care services prior to OBBBA’s July 4, 2025 enactment date; such contributions can be made before or after July 4, 2025. The IRS also affirmed it will refer to the Department of Health and Human Services (HHS) annual list of telehealth services payable by Medicare.² Services provided in person, as well as medical equipment or drugs given alongside telehealth or other remote care, cannot be covered before the deductible is met unless those items would themselves qualify as telehealth services under the current guidance.

Bronze and catastrophic plans now HSA-compatible

Beginning in 2026, bronze and catastrophic plans purchased through an ACA Exchange will be treated as HSA-compatible, even if they do not otherwise satisfy the HDHP minimum deductible and out-of-pocket maximum requirements. Bronze and catastrophic plans purchased off-Exchange will also be treated as an HDHP if the same plan is available as individual coverage through an Exchange (or if an individual reasonably believes that coverage is available on an Exchange). Employer-sponsored Individual Coverage HRAs (ICHRAs) or Qualified Small Employer HRAs (QSEHRAs) may be used to purchase these bronze and catastrophic plans without impacting HSA compatibility.

Direct Primary Care Service Arrangements

DPCSAs must follow specific rules to maintain HSA eligibility. The total monthly fee for all DPCSAs covering an individual cannot exceed $150, or $300 if the arrangement covers more than one person, with these limits adjusted for inflation after 2026. The only payment for care under a DPCSA should be the fixed periodic fee; members who pay this fee cannot be separately billed for additional items or services through insurance or other means.

However, DPCSAs may offer and bill for certain services outside the arrangement, regardless of membership status. Fees may be billed for periods longer than a month, up to one year, as long as the total does not exceed the monthly limit when averaged out. If a DPCSA provides services beyond permitted primary care, members cannot opt out of those services and still treat the arrangement as a DPCSA, and HDHPs cannot offer extra primary care benefits through a DPCSA before the deductible is met. Additionally, DPCSA fees do not count toward the HDHP’s annual deductible or out-of-pocket maximum.

For DPCSA fees to be reimbursed from an HSA, the arrangement must provide only primary care services from primary care practitioners, as defined in the guidance, and the sole compensation must be a fixed periodic fee. The care must not include prohibited services or items. While there is no specific dollar limit for HSA reimbursement, paying DPCSA fees above the monthly eligibility limit will make the individual ineligible to contribute to an HSA during that time. The guidance also clarifies when DPCSA expenses are considered incurred and therefore reimbursable, and notes that HSAs cannot reimburse fees paid by an employer, including those paid through cafeteria plan salary reductions.

Proposed rule eliminating Medicare Part D reporting requirements for HRAs

On November 28, 2025, the HHS Center for Medicare and Medicaid Services (CMS) issued a proposed rule³ that would eliminate the long-standing requirement for employers and administrators of HRAs to report whether their coverage is “creditable” for Medicare Part D purposes.

The proposed rule would remove this reporting requirement for HRAs and ICHRAs, while maintaining it for group health plans that directly offer prescription drug benefits.

CMS notes that this update aligns with efforts to reduce regulatory burdens and streamline compliance and is responsive to feedback from organizations seeking relief from these notice requirements.

CMS has issued a Request for Information concerning this proposed rule; the comment period ends January 26, 2026.