Most 2026 write ups list the new rules. Few tell you who on your roster they actually touch. That gap matters, because HSA eligibility is decided person by person, not plan by plan. A worker can sit inside your qualifying high deductible plan and still be locked out of an HSA by one disqualifying arrangement. Three of those old locks just came off.
The three OBBBA changes that widen HSA eligibility in 2026
The One Big Beautiful Bill Act became Public Law 119-21 on July 4, 2025. It changed the definition of who can fund a health savings account in three separate ways. Section 71306 made the telehealth safe harbor permanent. Section 71307 folded bronze and catastrophic exchange plans into the HDHP definition. Section 71308 said a qualifying direct primary care membership no longer counts as disqualifying coverage. Across all 331 pages of the act, those are the only three sections that amend the HSA rules.
Statute sets the rule. Guidance makes it operable. On December 9, 2025, the IRS released Notice 2026-5, a question and answer notice that spells out the fee caps, the effective dates, and the edge cases your benefits team has to work with. The rest of this guide reads that notice against your census.
Who on your census becomes newly eligible, and when
Pull your enrollment file. Three groups change status, each on its own clock.
| Worker segment | What changed for them | Effective date | Your first move |
|---|---|---|---|
| Sits in your HDHP and the plan already covers telehealth before the deductible | No longer at risk of losing HSA eligibility when the temporary relief lapsed. Now permanent | Plan years beginning after Dec 31, 2024, so this reaches the 2025 plan year | Confirm the carrier covers telehealth pre deductible, then document it |
| Holds a direct primary care membership alongside an HDHP | Membership stops being disqualifying coverage if the fee stays at or under the cap | Months beginning after Dec 31, 2025 | Verify the monthly fee and the fee structure against the cap |
| Enrolled in a bronze or catastrophic ACA exchange plan as individual coverage | That plan is now treated as an HDHP, so the person can open and fund an HSA | Months beginning after Dec 31, 2025 | Identify these workers, including anyone buying through an ICHRA |
Notice the split. Telehealth is retroactive. The other two start January 1, 2026. So one segment can true up a 2025 contribution, while the other two only begin their eligibility in the new year. Getting that timing wrong is how a well meaning employer creates an excess contribution.
Telehealth relief is permanent now and it reaches back to 2025
Here is the piece employers most often miss. The telehealth relief was never a niche perk. It was the reason a huge share of HDHP enrollees stayed HSA eligible while their plan covered virtual visits at no deductible. That relief was temporary. It applied through taxable years beginning before January 1, 2025, then lapsed. For a stretch of 2025, plans that kept first dollar telehealth were technically breaking their enrollees' HSA eligibility.
OBBBA closed that gap and made it retroactive. Per Notice 2026-5, the permanent extension applies for plan years beginning after December 31, 2024. An otherwise eligible worker may contribute to an HSA for 2025 even if, before the July 4 enactment, the plan covered telehealth before the minimum deductible was met. That is true whether the contribution went in before or after July 4.
One boundary. The no deductible treatment covers services on the annually published Medicare telehealth services list. In person services, equipment, or drugs furnished in connection with a virtual visit do not ride along under this safe harbor unless they independently qualify as telehealth. If your plan blends virtual and in person care, read the fine print with your carrier. For the broader case for virtual care, our guide to telemedicine benefits for employers walks through design and cost.
Direct primary care memberships stop blocking HSA eligibility
Direct primary care is a membership. A worker pays a flat monthly fee to a primary care practice and gets unhurried access to that clinician. Good model. Until 2026, it was also a poison pill for HSA eligibility, because the IRS treated it as other coverage that provided care before the deductible.
Section 71308 changed that. Under Notice 2026-5, a qualifying direct primary care service arrangement is not treated as a health plan that disqualifies the person, for months beginning after December 31, 2025. Two guardrails decide whether an arrangement qualifies.
- The fee cap. The arrangement is disqualified if aggregate monthly fees exceed 150 dollars for a single individual, or 300 dollars for an arrangement covering more than one person. The notice gives a clean annualized example. A single person could pay 1,800 dollars for a year, 900 dollars for six months, or 450 dollars for three months, and stay inside the cap. That cap is indexed for inflation for taxable years after 2026.
- The sole fee rule. The only compensation for the care must be that fixed periodic fee. An arrangement that bills separately for services, through insurance or otherwise, is not a qualifying direct primary care arrangement. Certain items also fall outside the definition of primary care here, including procedures requiring general anesthesia, prescription drugs other than vaccines, and lab work not typically done in an ambulatory primary care setting.
Read the cap carefully, because what breaks is eligibility rather than the money. If fees run over the limit, the notice still treats them as medical expenses an HSA can reimburse. What the worker loses is the right to keep contributing while enrolled in that arrangement.
The practical effect is large for employers piloting hybrid care. You can now pair a direct primary care membership with an HSA qualifying plan and keep the tax advantage intact, as long as the vendor contract respects both guardrails. For the deep dive on the DPC math and the actuarial evidence, see our dedicated resource on direct primary care and HSA compatibility in 2026.
Bronze and catastrophic exchange plans now count as HDHPs
This one reaches your part time, variable hour, and ICHRA populations. Section 71307 amended the HDHP definition to include a bronze or catastrophic plan available as individual coverage through an ACA Exchange. Notice 2026-5 confirms it applies for months beginning after December 31, 2025, and it applies even when the plan does not meet the usual minimum deductible or out of pocket rules for an HDHP.
A few operational points fall out of the notice.
- A plan bought off Exchange counts too, if the same plan is available as individual coverage through an Exchange.
- An employer sponsored ICHRA may be used to buy a qualifying bronze or catastrophic plan without breaking HDHP treatment. One condition rides with that, and it is the part most summaries drop. The ICHRA itself must reimburse premiums only. An ICHRA that also reimburses general medical expenses is still disqualifying coverage, and the worker stays locked out of an HSA no matter which plan the money buys. Our comparison of ICHRA and QSEHRA against the premium tax credit for 2026 is the companion read here.
- SHOP coverage is generally not individual coverage, so a bronze plan offered through SHOP is generally not swept in by this rule unless it independently meets HDHP requirements.
- Catastrophic plans carry their own enrollment limit. They are open to people who have not attained age 30 before the plan year begins, or to those with a hardship or affordability exemption. That shapes which of your younger or lower income workers this actually reaches.
What the newly eligible can actually save under the 2026 limits
Eligibility is only half the story. The other half is how much the newly eligible can put away, and that comes from Rev. Proc. 2025-19, released May 1, 2025. For 2026, the HSA contribution limit is 4,400 dollars for self only coverage and 8,750 dollars for family coverage. The HDHP minimum deductible is 1,700 dollars self only and 3,400 dollars family. The out of pocket maximum is 8,500 dollars self only and 17,000 dollars family.
Put the two documents together and the value gets concrete. A family that newly qualifies through a direct primary care membership can now shelter the full 8,750 dollars. In a 22 percent federal bracket, that keeps 1,925 dollars out of taxable income, and if the money goes to qualified medical expenses the tax is never paid at all rather than merely postponed. Route the contribution through a Section 125 cafeteria plan and it also escapes the 7.65 percent FICA payroll tax, roughly another 669 dollars for the worker, with the employer saving its own 7.65 percent on the same dollars. Two conditions sit under that second number. It only appears when the money moves by payroll deduction, so a worker who funds the account personally gets the income tax benefit and no payroll tax benefit. And once wages pass the Social Security wage base, only the 1.45 percent Medicare slice is left, which cuts that saving to about 127 dollars.
None of that value shows up if payroll is not ready to move pre tax dollars for these people. Employer contributions compound the effect. If you want a framework for how much to seed, our guide to employer HSA contributions for mid size companies in 2026 covers matching and flat funding strategies.
Plan design tripwires the 2026 dollar limits create
New eligibility comes with new ways to get burned. Four deserve a flag before you communicate anything to employees.
First, the bronze exposure gap. A bronze or catastrophic exchange plan is now an HDHP by statute even when its out of pocket maximum sits above the 8,500 dollar self only figure that defines an ordinary HDHP. So a worker gains HSA access while potentially carrying more downside cost exposure than a traditional HDHP enrollee. Weigh that when you steer people toward these plans. Our analysis of the 2026 HDHP out of pocket cap and family plan design shows how that gap plays out.
Second, the direct primary care cap is a hard line, not a target. Cross 150 dollars single or 300 dollars family in aggregate monthly fees and the whole arrangement flips back to disqualifying. If a vendor bundles services that push the effective fee over the cap, or bills separately outside the flat fee, the person loses HSA eligibility for those months.
Third, do not let the membership fee wander into the health plan. The notice is explicit that an HDHP may not pay direct primary care fees before the deductible is met, and that those fees do not count toward the deductible or the out of pocket maximum. Benefits teams get this backwards often enough that it is worth putting in writing to the carrier and to the vendor before renewal.
Fourth, mid year eligibility needs the testing period. A worker who becomes HSA eligible partway through 2026 can use the last month rule to contribute the full annual amount, but only if they stay eligible through the testing period that runs to the end of the following year, per IRS Publication 969. Break eligibility early and part of the contribution becomes taxable, with a 10 percent additional tax on top.
Your employer action checklist before open enrollment closes
The window is open enrollment. Work this list in order.
- Segment the census. Flag every worker who fits one of the three groups above. Telehealth touched, direct primary care members, and bronze or catastrophic exchange enrollees including ICHRA buyers.
- Lock in the telehealth position. Confirm with your carrier that the plan covers telehealth pre deductible and that the coverage tracks the Medicare telehealth list. This is retroactive, so it also affects 2025 contribution room.
- Vet every direct primary care contract. Get written confirmation that the aggregate monthly fee stays at or under 150 dollars single and 300 dollars family, and that the sole compensation is the flat periodic fee with nothing billed separately.
- Update the plan documents. Material changes to a benefit generally require a summary of material modifications furnished to participants, on the timing set by 29 CFR 2520.104b-3. Refresh the summary plan description and issue the SMM.
- Wire up payroll. Add or confirm Section 125 salary reduction elections and HSA deduction codes for the newly eligible so contributions run pre tax and escape FICA.
- Communicate by segment. Send each group a plain explanation of what changed, their new contribution room under the 2026 limits, and the testing period rule for anyone starting mid year.
Do the mapping first. Everything else depends on knowing exactly who on your payroll just gained a benefit they could not use last year.
Frequently Asked Questions
What is IRS Notice 2026-5?
It is guidance the IRS issued on December 9, 2025, explaining how the HSA changes in OBBBA work. It sets the direct primary care fee cap, confirms bronze and catastrophic exchange plans as HDHPs, and confirms the permanent telehealth safe harbor, with effective dates and edge cases, per Notice 2026-5. Written comments were due by March 6, 2026.
Which employees become HSA eligible in 2026?
Three groups. Workers whose HDHP covers telehealth before the deductible, workers with a qualifying direct primary care membership, and workers in a bronze or catastrophic ACA exchange plan bought as individual coverage. The telehealth fix reaches back to plan years after December 31, 2024, while the other two start January 1, 2026.
What is the direct primary care fee cap for HSA eligibility?
Aggregate monthly fees of 150 dollars for a single individual, or 300 dollars for an arrangement covering more than one person. The notice gives an annualized example of 1,800 dollars a year for one person. The cap is indexed for inflation for taxable years after 2026, and fees above it break eligibility while still counting as expenses an HSA can reimburse.
Can you contribute to an HSA with a bronze plan in 2026?
Yes, if the bronze plan is available as individual coverage through an ACA Exchange. For months beginning after December 31, 2025, that plan is treated as an HDHP, so an enrollee can open and fund an HSA, even when the plan's out of pocket maximum exceeds the usual HDHP limit.
Is the telehealth HSA safe harbor permanent?
Yes. Section 71306 of OBBBA made it permanent, and the extension applies retroactively for plan years beginning after December 31, 2024.
How much can a family contribute to an HSA in 2026?
Up to 8,750 dollars for family coverage and 4,400 dollars for self only coverage, per Rev. Proc. 2025-19. Account holders age 55 and older can add a catch up contribution on top.
About the author
Sam Newland, CFP, is the founder of Benefitra and advises mid market employers on benefits strategy, plan design, and compliance. He writes on the tax and regulatory changes that reshape how companies fund employee health coverage.
Published September 4, 2026. Last reviewed September 4, 2026.
This article explains federal tax rules as published and is not tax or legal advice for any specific employer. Confirm current year figures and your own facts with your adviser before acting.