Confusion Abounds: Which HSA Provisions Did Congress NOT Pass in the OBBBA?
By William G. Stuart | Originally posted on Health Savings Academy
There were a lot of moving parts as both chambers of Congress worked on the One Big Beautiful Bill Act this past spring. Let's be clear on which provisions did not pass.
Health Savings Account owners were optimistic when the House of Representatives passed its version of the reconciliation legislation, the One Big, Beautiful Bill Act, last May. The House version contained 10 provisions that industry advocates had fought for years to include in legislation to make Health Savings Accounts more accessible and easier to use.
When the Senate considered the bill, it immediately stripped all 10 provisions. Eventually, two of them, plus one not included in the House version, made it into the final draft that passed the Senate and became law. The three new provisions that did become law:
Telehealth. A permanent safe harbor permitting insurers and employers to cover virtual medical visits below the deductible, with no patient cost sharing. This had been the law for most of the time since early in the Covid-19 pandemic, but the provision had expired. It is now permanent, and retroactive to Jan. 1, 2025.
Direct-primary care. Patients who participated in a direct-primary care arrangement were not eligible to open and fund a Health Savings Account, even if they met all other eligibility requirements. Under a DPC arrangement, a patient pays a set monthly fee (often adjusted for age and level of health) and incurs no financial responsibility for primary-care services rendered by that physician. Now, beginning in January 2026, these arrangements are not disqualifying if the monthly fee does not exceed $150 per person or $300 per family. As a bonus, the fee is qualified for tax-free reimbursement from a Health Savings Account (but not a Health FSA).
Bronze and Catastrophic plans sold through government-facilitated marketplaces. These plans will, effective Jan. 1, 2026, meet the definition of an HSA-qualified plan, allowing otherwise-HSA-eligible enrollees to open and fund a Health Savings Account. About 7 million Americans are covered by Bronze plans and another 220,000 or so by Catastrophic coverage.
So, which provisions were left on the cutting-room floor? Here are the most meaningful:
Contributing after You Enroll on Medicare
The House bill contained the long-sought provision permitting working seniors (not all Medicare enrollees) who enrolled on Medicare Part A to remain HSA-eligible if they met all other eligibility requirements. This change would have allowed lower-income working seniors, whose receiving Social Security benefits to supplement their incomes triggers automatic enrollment in Part A, to continue to receive employer contributions and make pre-tax payroll deductions to fund their Health Savings Account.
Today, their enrollment in any Part of Medicare, even if they neither want nor use the benefit, disqualifies them from making and receiving the same contributions that their younger and more well-off fellow seniors receive.