On December 9, 2025, the IRS released IRS Notice 2026-5, which offers guidance regarding modifications to HSAs instituted by the One, Big, Beautiful Bill Act (OBBBA), enacted on July 4, 2025. These changes involve telehealth services, bronze and catastrophic plans, and direct primary care service arrangements (DPCSAs).
Telehealth Services
The OBBBA permanently allows group health plans to offer telehealth services to HDHP participants before deductibles are met, without affecting HSA eligibility, and applies retroactively to plan years starting after December 31, 2024. The notice states that eligible individuals can contribute to an HSA for 2025 if, prior to the July 4, 2025, enactment of the OBBBA, they were enrolled in a plan covering telehealth before meeting the deductible, if the plan otherwise qualifies as an HDHP, regardless of when the contribution is made.
This relief extends to services that are included on the list of telehealth services payable by Medicare, published annually by HHS. The guidance also provides instructions for determining whether a service not on this list qualifies for this relief. However, this relief does not apply to in-person services, medical equipment, or drugs provided alongside those services — unless they would otherwise be considered telehealth services.
Bronze and Catastrophic Plans
The OBBBA redefined HDHP to include bronze and catastrophic exchange plans, even if they don't meet the usual deductible or out-of-pocket limits. A person enrolled in these plans can be eligible to make or receive contributions to an HSA. The notice clarifies that this change applies to such plans bought with an employer-sponsored ICHRA, as well as plans purchased off-exchange.
Direct Primary Care Service Arrangements (DPCSAs)
The OBBBA allows DPCSAs with monthly fees up to $150 per individual or $300 per family to qualify for HSA eligibility. The notice clarifies that compensation for DPCSA services under such arrangements can only be made through a fixed periodic fee. DPCSA fees may be billed for periods up to one year if the aggregate fees are fixed, periodic, and remain within the monthly limit when annualized. This condition also means that a DPCSA will not qualify if it provides certain healthcare items and services to individuals on the condition that they are members in the arrangement and have paid a fixed periodic fee but bills separately for those items and services (through insurance or otherwise). That said, providers can offer and bill separately for services outside of a qualifying DPCSA.
If a plan offers services that go beyond approved primary care, its members cannot simply choose not to use those extra services and still consider it a DPCSA. In addition, HDHPs cannot count DPCSA fees toward an HDHP deductible or out-of-pocket maximum.
To be eligible for HSA reimbursement, a DPCSA must provide only primary care services by qualified primary care practitioners, with payment as a fixed regular fee, and must not include certain disallowed services or items. Disallowed services and items include 1) procedures that require the use of general anesthesia, 2) prescription drugs other than vaccines, and 3) laboratory services not typically administered in an ambulatory primary care setting.
While there is no set limit on this fee for HSA reimbursements, if the DPCSA fee exceeds the monthly threshold for HSA eligibility, the individual cannot contribute to their HSA during those months. The guidance details when HSA funds can be used for DPCSA expenses, noting that only out-of-pocket fees can be reimbursed. HSAs also cannot reimburse fees already paid by an employer, including those made via cafeteria plan salary reductions.
Employer Takeaway
Employers that offer HDHPs and HSA programs should be aware of this new guidance, particularly when evaluating or adopting DPCSAs. Public comments are requested on all aspects of the notice and must be submitted on or before March 6, 2026.
Read the full Notice 2026-5 on the IRS website.