Game-changing HSA legislation unlocks healthcare savings for millions of ACA plan enrollees

A sweeping legislative breakthrough was signed into law this week, redefining the landscape of Health Savings Accounts (HSAs) and how Americans engage with their healthcare finances. The “One Big Beautiful Bill” (OBBB), now enacted, marks a historic expansion of HSA eligibility, bringing millions of individuals enrolled in Bronze or Catastrophic plans under the Affordable Care Act (ACA) into the fold. Also included in the reform are modern healthcare modalities like Direct Primary Care (DPC) and telehealth, which are now recognized as qualified expenses under HSA rules starting January 1, 2026.

The landmark bill received broad bipartisan support and has been praised by digital health innovators like Lively, Inc., a San Francisco-based health and lifestyle benefits platform known for its next-generation HSA infrastructure. The American fintech-healthcare hybrid has positioned itself as a key player in simplifying health benefits access and administration for individuals, employers, and brokers alike.

What changes under the new HSA law and how does it expand access for ACA plan participants?

The most transformative element of the new legislation is the elimination of restrictive eligibility clauses that previously excluded enrollees in Bronze and Catastrophic-tier ACA plans from contributing to Health Savings Accounts. Historically, HSA participation was limited to those with High Deductible Health Plans (HDHPs) that complied with narrow federal definitions. These restrictions inadvertently left out the largest share of marketplace users—those who opted for lower-premium Bronze or Catastrophic coverage options.

With the signing of OBBB, individuals on these plans will now qualify for HSA contributions and tax savings beginning in the 2026 calendar year. This marks the first time since HSAs were introduced in 2003 that such a significant expansion of eligibility has taken place.

Institutional sentiment surrounding the move is highly favorable. Analysts view the reform as a way to inject more flexibility, financial control, and long-term savings potential into the U.S. healthcare system. Healthcare economists have long argued that enabling HSA contributions across all ACA-compliant plans would increase engagement, drive down total system costs, and promote health equity.

How does the legislation permanently allow telehealth and Direct Primary Care under HSA usage?

In addition to expanding eligibility, the law codifies the inclusion of two major modern healthcare models—telehealth and Direct Primary Care—as eligible HSA-qualified services. During the COVID-19 pandemic, emergency federal waivers temporarily allowed first-dollar telehealth services without disqualifying a plan’s HSA status. However, that temporary flexibility expired in 2023, leaving millions in limbo.

OBBB resolves this by making first-dollar telehealth access a permanent HSA-compatible expense. Now, HSA account holders can freely use pre-tax savings to cover virtual consultations, mental health video visits, and chronic condition follow-ups without running afoul of tax rules.

Additionally, Direct Primary Care—a fast-growing model where patients pay monthly fees for unlimited access to a primary care physician—is now officially eligible for HSA reimbursement. This change supports an ongoing shift in U.S. healthcare from insurance-centric models to value-based, subscription-style arrangements that emphasize preventive and continuous care.

Policy advocates argue that these inclusions bring HSA policy into the 21st century, aligning financial tools with how Americans increasingly seek care. For digital-first providers and hybrid health plans, the permanent status of telehealth and DPC coverage marks a regulatory green light for further innovation.

Why are digital benefits platforms like Lively poised to capitalize on the HSA policy shift?

Lively, Inc., which currently offers a full suite of tax-advantaged benefits accounts including HSA, FSA, HRA, and Lifestyle Spending Accounts, has spent years building a flexible platform designed to adapt to such regulatory tailwinds. According to company statements, its HSA infrastructure already supports integration with over 95% of U.S. health plans and is optimized for digital-first offerings including telehealth and DPC.

CEO and co-founder Alex Cyriac called the bill’s passage more than a regulatory update—it is, he said, “a redefinition of how Americans can save, spend, and stay healthy.” Lively’s real-time syncing technology, which pulls data from a user’s healthcare plan to ensure eligibility and compliance, positions it as a market leader in ensuring seamless transition into the new benefits era.

For employers and brokers, Lively offers rapid onboarding tools, zero hidden fees, and real-time eligibility checks. These features are likely to play a major role in expanding HSA adoption among both ACA users and employer-based populations transitioning to hybrid plans.

As institutional investors evaluate fintech-health companies, platforms with proven integration capabilities and adaptable compliance layers—such as Lively—are receiving increased attention. Analysts expect a surge in account signups in Q4 2025 as users begin preparing for the January 2026 effective date.

What impact could this HSA expansion have on healthcare consumer behavior and savings rates?

Economists predict the law could add more than 12 million new HSA-eligible individuals by 2026. Currently, there are approximately 37 million active HSA accounts in the U.S., with an average balance of $3,000. Expanding eligibility to ACA Bronze and Catastrophic plan holders—who historically represent 60–70% of marketplace enrollments—could increase total account volumes by over 30% in just two years.

The move is also expected to have ripple effects on U.S. consumer financial behavior. HSAs offer triple tax advantages—pre-tax contributions, tax-free growth, and tax-free withdrawals for qualified medical expenses—which analysts say make them a better long-term vehicle than even Roth IRAs in certain contexts.

However, public awareness and financial literacy around HSAs remain low. That’s where companies like Lively play a crucial role. The American benefits platform includes automated education modules, guided onboarding, and smart tools to help users understand how to maximize their savings over time.

Long-term, analysts believe the reform will shift U.S. healthcare consumerism toward proactive health management. With access to digital primary care and virtual visits via tax-advantaged funds, individuals will be more empowered to seek early intervention and preventive care.

How are financial markets and institutional investors responding to the HSA eligibility expansion?

While Lively remains privately held, market watchers are observing a surge in interest across the broader benefits administration and healthcare fintech space. Publicly traded players in the benefits and insurance brokerage arena, such as HealthEquity (HQY), have seen upticks in analyst sentiment as expectations for HSA account expansion grow.

Institutional investors believe the law unlocks a new growth vector for HSA custodians, particularly those with existing integration into digital-first and employer-sponsored healthcare plans. Platforms that support real-time plan syncing, API-driven eligibility verification, and scalable administration tools are expected to lead the next phase of growth.

Moreover, the inclusion of Direct Primary Care and telehealth services aligns with investor expectations that the future of healthcare will be hybrid, decentralized, and digitally augmented. Analysts expect venture capital interest to return to the DPC infrastructure and benefits space, especially as tax-advantaged tools like HSAs begin covering these expenses.

What is the future outlook for HSA policy, fintech integration, and consumer adoption by 2026?

Looking ahead, analysts expect further refinements in HSA policy to improve accessibility, transparency, and portability. Proposals are already circulating to increase contribution limits beyond the current $4,150 for individuals and $8,300 for families, citing inflation and growing out-of-pocket costs.

Platforms like Lively are also exploring AI-powered insights to help users make smarter healthcare spending decisions. Their platform roadmap includes predictive balance tracking, tax optimization insights, and employer analytics to fine-tune benefits strategies.

Consumer adoption is expected to rise sharply in the 18–35 demographic, driven by increasing enrollment in ACA plans and a cultural shift toward personal finance autonomy. As the healthcare industry becomes more consumer-centric, HSAs will likely play a critical role in empowering individuals to budget, plan, and invest in their well-being.

With implementation slated for January 2026, stakeholders across the ecosystem—from consumers and employers to benefits platforms and digital providers—are moving swiftly to align operations and communications with the new reality.