Health Savings Account (HSA) plan rules just got a refresh for 2026, and smart employers are updating their playbooks. In the wake of the One Big Beautiful Bill Act (OBBBA) and other recent shifts, companies are “rewriting the rules” of how their HSA-eligible health plans operate. As a broker or benefits consultant, you need to be ahead of these changes.
They present an opportunity for you to guide clients through new options (and avoid pitfalls), further cementing your role as a strategic advisor. Let’s break down what’s driving employers to revisit their HSA-linked plans—and how you can capitalize on it.
During the pandemic, many employers added free telehealth benefits to their high-deductible health plans (HDHPs) thanks to temporary relief. That relief expired, and some plans had to drop those first-dollar telehealth perks to maintain HSA eligibility. Enter OBBBA: the law permanently extended the HSA safe harbor for telehealth, effective with 2025 plan years.
In plain English, an HDHP can cover telehealth visits at no cost (or low cost) before the deductible and still be HSA-qualified. Employers are seizing this change to enrich their plans again, now that first-dollar telehealth coverage is permanently allowed for plan years beginning after December 31, 2024, according to the McDermott Will & Emery analysis1.
For brokers, this means two things. First, make sure your clients know they can re-integrate telehealth coverage into their HDHPs without jeopardy. Many employers were disappointed to drop $0 telemedicine; now they can bring it back for 2026 and beyond.
In fact, they’re allowed (but not required) to cover unlimited remote care pre-deductible going forward. Second, there’s a compliance aspect: plans that do extend telehealth benefits should update their plan documents accordingly and communicate the change, a step employer-focused advisories emphasize for OBBBA-related plan updates according to the Alston & Bird employer benefits update8.
For example, if an employer decides to waive copays for virtual primary care visits, those provisions should be reflected in the Summary Plan Description or an official amendment. As their broker, you can add value by flagging this and even providing template language for SPDs. It’s a chance to show your expertise in the fine print that clients might overlook. And on the employee side, encourage clients to tout the telehealth benefit – utilization is likely to be strong since people love the convenience (and now it’s truly free to use with an HSA plan).
Perhaps the biggest buzz in the HSA world is the new allowance for Direct Primary Care (DPC). Starting Jan. 1, 2026, an individual can participate in a DPC subscription and still contribute to an HSA. Previously, paying a monthly fee to a primary care clinic (even for basic services) was considered disqualifying other coverage.
OBBBA carved out an exception: as long as the DPC fee is ≤$150/month for single coverage (or ≤$300 for family) and covers only primary care, it won’t break HSA eligibility. Moreover, those DPC fees are now explicitly defined as qualified medical expenses for HSA use, according to the White House HSA eligibility briefing6 and summarized for plan sponsors by the International Foundation of Employee Benefit Plans3.
This is a game-changer for plan design innovation. Employers are effectively rewriting their HSA plan rules to incorporate DPC options. For instance, an employer might offer an HDHP alongside an optional DPC membership to give employees enhanced primary care access. In 2026, that’s a viable combo – employees can do both. As a broker, you should be ready to advise on how to implement these arrangements.
Key considerations include: ensuring the DPC vendor’s services meet the criteria (no major procedures or broad specialist care, since the law limits DPC to primary care scope) and deciding whether the employer will subsidize the DPC fee. OBBBA and related guidance clarify that qualifying DPC arrangements must consist solely of primary care services and stay under the $150/$300 monthly fee limits, according to analyses from the National Law Review4 and the DLA Piper HSA–DPC bulletin10.
Some employers may cover the DPC fee entirely as a benefit (justifying it by potential claim savings), while others might offer it as a voluntary add-on. Either way, you’ll need to guide them on handling the logistics. Also, keep an eye on whether offering a DPC might trigger any ERISA or ACA compliance requirements (the law is a bit gray on whether an employer-sponsored DPC is considered a group health plan; legal counsel can weigh in), an issue flagged in several employer-focused legal updates on the Act11.
Importantly, note what didn’t change: traditional on-site clinics. Many hoped the bill would also allow free on-site workplace clinic services without HSA conflicts. A provision for that was proposed but ultimately left out of the final law. This means if your client runs an on-site clinic providing more than very limited care (beyond first aid or certain preventive services), employees with HSAs could still be ineligible, as noted in legal summaries of the Act’s final provisions11.
To avoid issues, advise clients to keep any broad on-site clinic offerings to post-deductible services or charge fair market value for visits. Until we see a legislative fix in the future, this remains an area to handle carefully. You can demonstrate value by conducting an “HSA compliance check” on any client-provided health clinics or similar benefits. It’s better to proactively adjust those programs than to inadvertently disqualify employees’ HSAs.
Another subtle but significant shift: millions more Americans will be HSA-eligible in 2026 due to a change involving ACA marketplace plans. OBBBA expanded the definition of HSA-qualified plans to include all Bronze and Catastrophic plans on the exchanges. In the past, many of those plans weren’t HSA-qualified because they covered certain benefits before the deductible.
Starting in 2026, that’s fixed. Effective January 1, 2026, Bronze and Catastrophic plans offered on ACA Exchanges will be treated as HSA-compatible high-deductible health plans, regardless of whether they meet traditional HDHP rules, according to analyses from Western CPE5 and the federal HSA-eligibility briefing6.
How does this affect employer plans? For one, if you have any clients using Individual Coverage HRAs (ICHRAs) or otherwise steering folks to the individual market, those employees could now open HSAs with their Bronze/Catastrophic coverage. It’s a point worth mentioning, as part-timers or contractors might benefit. More broadly, this expansion bolsters the HSA ecosystem – more people with HSAs means more familiarity and comfort with consumer-driven health.
Employers might see increased employee demand to offer an HSA-compatible plan option. If a client has been on the fence about adding an HDHP/HSA choice, 2026 could be the tipping point year to do it, knowing the government is reinforcing the HSA model and explicitly expanding eligibility, as summarized in plan-sponsor guidance from Lively7.
On that note, it’s worth dispelling a misconception: some headlines made OBBBA sound like a massive HSA overhaul. In reality, the HSA tweaks are modest but meaningful. For example, a much-talked-about proposal to allow HSA contributions for those enrolled in Medicare Part A did not pass, nor did an idea to substantially raise annual HSA contribution limits, as confirmed in detailed legislative summaries of the final bill text14.
So we’re not in a radically different HSA world – but we do have important new flexibility in how HSAs and primary care intermix. As a broker, your value lies in understanding these nuances and helping clients navigate them.
What does all this mean for you and your clients? Here are a few actionable takeaways for navigating the new HSA plan rules.
Proactively reach out during plan renewals to discuss the telehealth safe harbor. If a client’s HDHP dropped telehealth coverage in 2025, suggest re-adding it for 2026. Have data ready on telemedicine utilization and employee feedback to strengthen the case. Being the messenger of “good news – we can add your $0 telehealth back” positions you as a knowledgeable advisor.
Bring DPC into strategic discussions for 2026. Even if a client isn’t ready to pull the trigger, introduce the concept now that it’s HSA-compatible. You might say, “With the rule change, we could integrate a direct primary care option to give employees more personalized care. It’s something to consider for boosting quality and potentially lowering long-term costs.” This plants the seed and shows you’re on top of industry trends. If they are interested, you can help evaluate providers and structure the benefit (for instance, deciding whether the DPC fee is employer-paid or voluntary, and ensuring any offering meets the law’s requirements).
Audit existing wellness/clinic programs for HSA conflicts. Ensure that freebies like on-site health clinics, employer-paid “mini-med” programs, or even rich preventive drug lists in the HDHP are aligned with HSA rules. With regulations evolving, it’s a good time to double-check. Clients will appreciate you safeguarding them from compliance slip-ups.
Educate employees (through your clients). When plan changes occur – e.g., telehealth is now free again, or a new DPC benefit is added – help your clients communicate the value to their people. Many employees don’t fully grasp HSA nuances; clear messaging that “you can now use telehealth without cost-sharing and still contribute to your HSA” or “our new primary care membership benefit is HSA-eligible” will boost appreciation and usage. Provide newsletter blurbs or host a webinar for HR to ensure employees understand and take advantage of these enhancements.
In summary, employers are indeed rewriting a few rules in their HSA plans – mainly to enrich benefits (telehealth, DPC) that were previously constrained. For brokers, this is an opportunity to play the hero who brings fresh solutions and ensures compliance. By staying on top of HSA legislation and proactively adjusting plan designs, you reinforce that you’re not just a vendor but a true partner in your clients’ success.
When you help a client implement a more robust, HSA-friendly plan that employees love, you’re also writing a new chapter in your own playbook – one where your advisory expertise shines.
Download the Broker Toolkit here for a handy checklist on 2026 HSA plan updates, including telehealth implementation steps and DPC vendor evaluation criteria.