The IRS has issued guidance addressing common questions regarding the HSA-related changes made the by the One Big Beautiful Bill Act (OBBBA), enacted in July 2025. The OBBBA made permanent the safe harbor allowing high-deductible health plans (HDHPs) to cover telehealth and other remote care services before the minimum deductible is satisfied without losing their HDHP status and participant HSA eligibility. OBBBA also provides that bronze and catastrophic plans available as individual coverage through an Exchange will be treated as HDHPs. In addition, direct primary care service arrangements (DPCSAs) will not adversely affect HSA eligibility if certain requirements are met, and the fees for these arrangements are qualified medical expenses for HSA purposes. Here are highlights of the guidance:
- Telehealth/Remote Care: OBBBA permanently extends the telehealth safe harbor allowing QHDHPs to provide telehealth services on a pre-deductible basis without destroying HSA eligibility. This relief applies retroactively to plan years beginning after December 31, 2024. The IRS also clarified that telehealth and other remote care services qualify if such services appear on HHS’s annually published list of telehealth services payable by Medicare. In-person services, medical equipment, or drugs furnished in connection with telehealth and other remote care services may not be provided pre-deductible unless they would otherwise be treated as telehealth services under the guidance.
- Bronze/Catastrophic Plans: For plan years beginning after 2025, bronze or catastrophic plans will be treated as HDHPs if they are available as individual coverage through an Exchange, even if they do not satisfy the HDHP minimum annual deductible or out-of-pocket maximum requirements. Furthermore, employer-sponsored ICHRAs can be used to purchase the coverage.
- DPCSAs and HSA Eligibility: Beginning January 1, 2026, qualifying DPCSAs will not destroy HSA eligibility. To qualify, the DPCSA must provide only primary care services rendered by primary care practitioners (i.e., primary care doctors, internists, geriatric doctors or pediatricians, plus mid-level staff in those areas) for a fixed period fee that does not exceed $150 per month (or $300 if the arrangement covers more than one individual), as adjusted annually for inflation. The services provided cannot include general anesthesia, prescription drugs (other than vaccines) or lab services not typically provided in a primary care setting. The sole compensation for care provided under a DPCSA must be the fixed periodic fee and DPCSAs may not provide items and services to individuals who are members in the arrangement and have paid a fixed periodic fee while billing separately for those items and services (through insurance or otherwise). However, DPCSAs may offer certain items and services outside of the arrangement regardless of membership, and separately bill members and non-members for those items and services. If an arrangement provides services other than permitted primary care services (such as prescription drugs other than vaccines), members in the arrangement may not decline to use those services and treat the arrangement as a DPCSA. And an HDHP may not count an individual’s DPCSA fees toward the HDHP’s annual deductible and out-of-pocket maximum.
- Reimbursing DPCSA Fees: Fees for qualifying DPCSAs may now be paid from a HSA.
Employers, administrators, and advisors who work with HSAs and HDHPs should familiarize themselves with the guidance and determine whether changes may be needed or advisable to programs and offerings.
