In Notice 2026-5, the IRS issued guidance on the expanded Availability of Health Savings Accounts under the One, Big, Beautiful Bill Act ("OBBBA").  There are three main questions the guidance addresses:

1. What telehealth and other remote care services can be provided to an individual who is contributing to an HSA? 

2. When are bronze and catastrophic coverage treated as high deductible health plans?    

3. When do direct primary care arrangements preclude an individual from contributing to an HSA (as well as related guidance about payment of fees for these arrangements from HSAs).

While the guidance provides some helpful clarification, it points the public to other, not very straightforward, sources for determining which telehealth services may be provided, which is not entirely helpful.  In addition, it takes a surprisingly broad view and permits an individual who does not even purchase a bronze or catastrophic plan available through an Exchange to be HSA-eligible, but again, the guidance points the public to other sources to determine whether the rules are satisfied.  Finally, the guidance on direct primary care arrangements leaves a lot of questions unanswered and suggests that, except for a narrowly defined arrangement, an individual cannot participate in a direct primary care arrangement and contribute to an HSA at the same time.

Fortunately, the Treasury Department and the IRS request comments on all aspects of this notice. Written comments are due on or before March 6, 2026.

* * *

For deep dive coverage, topic-specific analysis, and other Groom benefits, health, and retirement content, visit our website at www.groom.com.