One Big Beautiful Bill: IRS Guidance Brokers Must Understand on HSA Changes

Quick Answer 

IRS Notice 2026-5 clarifies how the One, Big, Beautiful Bill Act expands HSA flexibility. Telehealth at low or no cost is permanently HSA-compatible and retroactively safe for 2025, while new guardrails apply to Direct Primary Care and Bronze or Catastrophic plans starting in 2026. Brokers should help employers confirm plan design, payroll treatment, and employee communications now to avoid unintended HSA disqualification.

Why Brokers Should Pay Attention Now

If you felt like the One Big Beautiful Bill answered the “what” but left the “how” fuzzy, you weren’t wrong. Since July, brokers have been fielding questions from employers offering first-dollar telehealth, exploring DPC models, or expanding ICHRA strategies tied to HSAs.

The IRS finally filled in some of the gaps with Notice 2026-5. The good news is that much of what employers already did in early 2025 is protected. The risk is assuming that all DPC or HSA strategies are automatically compliant moving forward. This is where brokers add real value.

Telehealth and HSAs: Retroactive Relief Confirmed

What Changed

The law permanently allows HSA-eligible employees to access telehealth and other remote care services before meeting the deductible.

What the IRS Clarified

• The flexibility applies retroactively to January 1, 2025.

• Employers that offered low- or no-cost telehealth in early 2025, before the law passed, did not create HSA-disqualifying coverage.

• There is no gap in HSA eligibility for those employees.

  
  

What Still Matters

Only telehealth services qualify for this exception. If a virtual visit leads to in-person care, prescriptions, equipment, or labs, those follow standard HDHP deductible rules.

How brokers should explain it to employers: Your $0 telehealth strategy is safe for HSAs. Just make sure employees understand where telehealth ends, and deductible rules resume.

Direct Primary Care: More Flexibility, More Traps

Starting in 2026, certain DPC arrangements can coexist with HSAs. IRS Notice 2026-5 added a critical detail.

Cost and Structure Rules

• DPC fees that exceed the $150 monthly limit (double for a family) are still reimbursable from an HSA, as long as the employee paid the fee after-tax.

• Fees do not have to be charged monthly.

  • Quarterly or annual fees are allowed as long as they stay within the annual limit.

• Fees can be paid shortly before the coverage period begins.

  
  

Services Rules

• DPC must focus on primary care services.

• DPC cannot include services requiring general anesthesia, most drugs, or labs not typical for ambulatory care.

• DPC providers may offer additional services for extra fees without violating the rules.

  
  

Critical Compliance Clarifications

• DPC fees cannot count toward the HDHP deductible.

• Employees cannot “double dip.”

  • If DPC fees are paid pre-tax through a Section 125 plan or paid by the employer, they cannot also be reimbursed from an HSA.

• All DPC fees are HSA-reimbursable, even if the DPC arrangement itself is not HSA-compatible, as long as the employee paid the fee after tax.

  
  

Broker takeaway: DPC can work with HSAs, but only if payroll treatment, fee structure, and employee communications are aligned.

Bronze and Catastrophic Plans: New HSA Pathways in 2026

Beginning in 2026, Bronze and Catastrophic individual plans are treated as HSA-compatible coverage.

What This Means for ICHRAs

• ICHRA reimbursements must be limited to premiums only to avoid disqualifying HSA eligibility.

• Employers using a Section 125 plan must obtain employee attestations confirming HSA-compatible coverage before allowing pre-tax deductions or HSA contributions.

  
  

Off-Exchange Plans Get Relief

If an employee enrolls in a Bronze or Catastrophic plan off the Exchange, the IRS will not require employers to verify whether the exact plan is sold on the Exchange, as long as the employee has no reason to believe otherwise.

Broker Action Steps

• Review HDHP designs to confirm telehealth coverage aligns with the permanent HSA rules.

• Audit any DPC offerings for fee structure, service scope, and payroll treatment.

• Coordinate with payroll and Section 125 administrators to prevent double-dipping.

• Update ICHRA communications and employee attestations ahead of 2026.

• Set expectations with employers that DPC integration requires careful compliance review.

FAQs Brokers Can Share With Clients:

Does low-cost telehealth still affect HSA eligibility? No. Telehealth can be offered before the deductible without affecting HSA eligibility, retroactive to January 1, 2025.

Do DPC fees have to be charged monthly? No. Fees can be monthly, quarterly, or annual as long as they do not exceed the annual equivalent of $150 per month, or double for family coverage.

Can DPC fees count toward the HDHP deductible? No. DPC fees cannot be applied toward meeting the federal HDHP deductible.

Are DPC fees exceeding the cost limit reimbursable from an HSA? Yes, as long as the employee paid the fee after tax. Pre-tax or employer-paid DPC fees are not HSA-reimbursable.

Can Bronze or Catastrophic plans work with HSAs? Yes. Starting in 2026, these plans are treated as HSA-compatible coverage.

Final Thoughts

The One Big Beautiful Bill created real opportunity, but IRS Notice 2026-5 makes it clear that details matter. Telehealth is simpler. DPC and ICHRA strategies are not.

Brokers who help employers slow down, structure these arrangements correctly, and document decisions will protect HSA eligibility and their own credibility. At BCS, our role is to translate evolving guidance into practical, defensible compliance strategies so brokers can lead with confidence.