President Trump's One, Big, Beautiful Bill Would Expand HSAs to Another 20 Million People

President Trump’s One, Big Beautiful Bill (OBBB) could soon allow another 20 million Americans access to health savings accounts (HSAs).

The OBBB contains provisions that would expand access to HSAs to new groups, expand and clarify the types of care covered by HSAs, and offer bigger HSA tax exemptions to low-income households.

HSAs already provide coverage to more than 72 million Americans. These accounts make it easier for individuals to save, invest, and spend pre-tax dollars on healthcare: contributions are tax-deductible, earnings are tax-free, and withdrawals are tax-free when used for qualified medical expenses.

HSAs offer several key benefits: choice, portability, and cost savings. Workers can choose the providers and treatments that work best for them, rather than being locked into narrow insurance networks. HSAs are owned by the individual, not the employer, meaning they’re fully portable from job to job. HSAs also encourage smarter healthcare spending: one study tracking over 76,000 enrollees for three years found that HSA users spent 5–7 percent less than those with traditional employer-provided insurance.

OBBB would allow more Americans to enjoy these benefits and help lower exorbitant costs in the American healthcare sector.

HSAs Opened Up to Seniors, Spouses, and Working Families

The One, Big, Beautiful Bill would tear down outdated restrictions on who can save in a Health Savings Account. For the first time, seniors who are eligible for Medicare Part A would be able to contribute to an HSA, preserving access to tax-free savings well into retirement. Married couples would be able to make catch-up contributions to the same HSA, simplifying joint saving and filing. Individuals would no longer be disqualified from HSA participation just because their spouse has a Flexible Spending Account (FSA), provided that the FSA reimburses only that spouse’s expenses.

Families switching to a high-deductible plan after several years away would be able to roll over unused FSA or Health Reimbursement Account (HRA) balances directly into an HSA—tax-free—if they stay in a qualified plan for the remainder of the year. The bill even allows medical expenses incurred up to 60 days before the HSA is opened to count as qualified expenses, as long as High-Deductible Health Plan (HDHP) coverage is already in effect.

Direct Primary Care, Bronze Plans, and Clinics

The bill would bring common-sense clarity to which plans and services qualify for HSA use. Direct Primary Care (DPC) arrangements would be explicitly allowed, with reasonable monthly caps of $150 for individuals and $300 for families. Bronze and catastrophic plans would be considered high-deductible plans, making them fully compatible with HSA contributions.

On-site clinics provided by employers would be able to offer preventive care, immunizations, screenings, and basic services without jeopardizing HSA eligibility. This change would empower businesses to promote wellness without triggering Internal Revenue Service (IRS) penalties for their employees.

Rewarding Physical Wellness

The bill recognizes that preventive care doesn’t always happen in a doctor’s office. Americans would be able to deduct up to $500 per year ($1,000 for joint filers) for qualified fitness expenses, such as gym memberships or exercise classes. This simple, forward-looking reform would support health before illness and reduce long-term costs for everyone, advancing President Trump’s promise to Make America Healthy Again.

Increased HSA Contribution Limits for Working-Class Households

The bill increases the annual HSA contribution limit by $4,300 for individuals and $8,550 for families. These higher limits phase out at $75,000 for single filers and $150,000 for joint returns, targeting the benefit where it’s needed most: working families trying to stay healthy and financially secure.

Real Relief, Real Reform

The One Big Beautiful Bill would revolutionize how Americans save and spend on health care. It would expand HSA eligibility to groups like seniors and working families, simplify family contribution rules, clarify compatible insurance plans, reward fitness and wellness activities, and provide enhanced contribution limits for working-class families.

This comprehensive approach ensures that every American family has better options, more flexibility, and greater financial security when it comes to their healthcare choices.