Big news for 2026: 3 to 4 million more Americans are now eligible to open and contribute to Health Savings Accounts under new provisions in the One Big Beautiful Bill Act. If you've been locked out of HSA benefits because of your health plan type, direct primary care arrangement, or telehealth usage, everything just changed.
This isn't just about eligibility expansion. It's about empowering employees to maximize their pre-tax accounts with unprecedented flexibility. With HSAs now accessible to millions more people, understanding what you can actually buy with these accounts has never been more important.
Let's break down the 2026 changes, explore the comprehensive list of eligible expenses, and show you how to turn these tax-advantaged accounts into powerful tools for keeping your New Year's health resolutions.
The Game-Changing 2026 HSA Expansion
Starting January 1, 2026, three major groups gained HSA eligibility:
1. Bronze and Catastrophic Health Plan Holders
If you're enrolled in a bronze or catastrophic health plan sold through the ACA marketplace, you can now open and contribute to an HSA. Previously, most of these plans failed to meet the IRS's strict high-deductible health plan (HDHP) criteria, particularly rules limiting coverage of non-preventive care before the deductible is met.
"Bronze and catastrophic plans usually come with high deductibles, so confirming HSA eligibility removes confusion and gives people a way to offset out-of-pocket costs," says Harrison Newman, vice president at Corporate Synergies. "For those on tight budgets, the ability to save pre-tax dollars and reduce taxable income can make health care more affordable."
2. Direct Primary Care (DPC) Members
People using direct primary care arrangements can now use HSA funds to pay for these subscription-based services. In DPC programs, patients pay a flat monthly fee to their doctor for primary care services like office visits and wellness exams.
Previously, DPC arrangements were considered "other coverage" by the IRS, which prevented HSA eligibility. That disqualification ends in 2026, clearing up years of ambiguity for the 9% of family doctors now operating DPC practices (up from just 3% in 2022).
3. Telehealth Users
HDHPs can now permanently cover telehealth services before a deductible is met while still maintaining HSA eligibility. The new law makes this policy permanent retroactive to January 1, 2025.
"It's a big win for accessibility and cost savings," says Newman. "This change removes a major barrier that previously forced people to choose between virtual care and HSA contributions, a huge misstep that slowed HSA growth."
Understanding the 2026 HSA and FSA Landscape
With roughly 40 million HSA accounts holding nearly $160 billion, and now millions more eligible to join, understanding how to maximize these accounts is critical.
2026 Contribution Limits:
- Health FSAs: $3,300 (up from $3,200 in 2025)
- HSAs (Individual): $4,300
- HSAs (Family): $8,550
Here's what makes HSAs particularly powerful: unlike Flexible Spending Accounts (FSAs), which generally require you to use funds annually or lose them, HSA funds roll over year to year. There's no "use it or lose it" rule, and HSAs are portable if you change jobs.
"When used strategically, they can function like a stealth retirement account for health care, with unmatched tax benefits," says Newman. That's the triple tax advantage: contributions are tax-deductible, money grows tax-free, and withdrawals for qualified health care costs aren't taxed.
The Comprehensive Guide: What You Can Actually Buy
According to recent IRS guidance, there are now 500+ eligible items. Here's your complete breakdown:
Medical Care Essentials
- Doctor visits, specialists, and diagnostic tests
- Hospital services and emergency care
- Prescription medications and insulin
- Medical equipment and supplies
- Lab work and imaging (X-rays, MRIs, CT scans)
- Physical therapy and chiropractic care
- Acupuncture treatments
Dental & Vision
- Dental exams, cleanings, and X-rays
- Orthodontics and braces
- Eyeglasses and contact lenses
- Prescription sunglasses
- Laser eye surgery (LASIK, PRK)
- Eye exams
Mental Health & Wellness
- Therapy and counseling sessions
- Psychiatric care and evaluations
- Substance abuse treatment programs
- Meditation apps (when prescribed for mental health conditions)
- Sleep aids and CPAP machines
Fitness & Preventive Health (The Wellness Revolution)
This is where 2026 gets exciting. With fitness and wellness as top topics in the US right now, here's what qualifies:
- Exercise equipment for treating specific medical conditions (when prescribed)
- Standing desks and ergonomic chairs (with Letter of Medical Necessity)
- Weight loss programs for doctor-diagnosed obesity
- Nutritionist consultations (when medically necessary)
- Blood pressure monitors and glucose meters
- Fitness programs for chronic disease management
Reproductive Health
- Fertility treatments and monitoring
- Pregnancy tests and prenatal care
- Contraception
- Menstrual care products (tampons, pads, cups)
- Breast pumps and lactation supplies
Chronic Condition Management
- Diabetes supplies (test strips, lancets, monitors)
- Blood pressure equipment
- Mobility aids (wheelchairs, walkers, canes)
- Hearing aids and batteries
- Orthopedic supports and braces
Everyday Health Items
- Sunscreen (SPF 15+)
- First aid supplies
- Over-the-counter medications (pain relievers, allergy medicine, cold medicine)
- Thermometers
- Band-aids and wound care supplies
The Trumed Partnership: Expanding Wellness Access
Here's where it gets even better. Clarity has partnered with Trumed, a platform revolutionizing how employees access FSA and HSA funds for wellness purchases. With a Letter of Medical Necessity, employees can now use their pre-tax dollars for:
- Fitness memberships addressing specific health conditions
- Nutrition coaching programs
- Wellness programs for chronic disease management
- Health-focused equipment and services
This isn't about gaming the system, it's about recognizing that preventive health is real healthcare. A study by the American Journal of Preventive Medicine found that every dollar spent on wellness programs saves employers an average of $3.27 in healthcare costs.
Making It Work: Strategic HSA and FSA Usage
For New HSA Users
If you're one of the millions newly eligible in 2026:
- Open your account immediately - The sooner you start, the sooner your money grows tax-free
- Contribute the maximum if possible - Take full advantage of the triple tax benefit
- Save receipts - You can reimburse yourself years later, letting investments grow
- Consider it a retirement account - After age 65, you can withdraw for any purpose (taxed as ordinary income)
For Existing Account Holders
- Review your 2026 contribution limits and adjust payroll deductions
- Download the expanded list of eligible expenses
- Explore new wellness programs that qualify through Trumed
- Schedule preventive care appointments early in the year
- Set up auto-reminders for FSA funds (if applicable)
The Strategic Advantage
With HSA benefits administration properly managed, employees can:
- Reduce taxable income significantly
- Build long-term healthcare savings
- Access funds for immediate medical needs
- Cover family healthcare expenses tax-free
Why Technology Matters for Benefits Maximization
The expansion of HSA eligibility makes technology-first solutions more critical than ever. With millions of new users entering the market, seamless administration is essential.
Modern benefits platforms help:
- Automatically verify HSA eligibility under new rules
- Track eligible expenses across multiple account types
- Integrate with payroll for proper tax treatment
- Provide real-time balance updates and expense tracking
- Educate employees on maximizing their benefits
Common Mistakes to Avoid in 2026
Mistake #1: Not Checking New Eligibility If you have a bronze plan, catastrophic plan, DPC arrangement, or use telehealth, verify your HSA eligibility now. You may have been ineligible yesterday but eligible today.
Mistake #2: Mixing HSA and FSA Incorrectly You generally can't have both a healthcare FSA and HSA simultaneously (limited-purpose FSAs are the exception). Understand the rules before contributing.
Mistake #3: Not Using Available Funds With 70% of employees not fully utilizing their FSA or HSA benefits, billions of dollars in tax savings are left on the table annually.
Mistake #4: Missing the Trumed Opportunity Don't overlook wellness programs that now qualify with proper documentation. Your gym membership or nutrition coaching might be HSA-eligible.
Your 2026 Action Plan
Immediate Steps:
- Verify your HSA eligibility under new 2026 rules
- Calculate maximum contribution amounts based on your situation
- Set up payroll deductions to maximize tax benefits
- Research Trumed-eligible wellness programs
- Download the complete eligible expenses list
Throughout the Year:
- Use HSA/FSA funds for preventive care (100% covered under most plans)
- Keep all receipts and documentation
- Monitor changes to eligible expenses
- Take advantage of employer HSA contributions
- Review your strategy quarterly
The Bottom Line
The 2026 HSA expansion is a watershed moment. With 3 to 4 million newly eligible Americans and over 500 eligible expense categories, these accounts have evolved from niche healthcare tools to mainstream financial planning essentials.
HSAs and FSAs aren't just benefits, they're strategic tools for employee health and financial wellness. Whether you're newly eligible or optimizing existing accounts, the expanded options and wellness focus mean 2026 is the year to maximize your pre-tax healthcare dollars.
The question isn't whether you should maximize your HSA or FSA. It's whether you can afford not to.
Ready to help your employees maximize their HSA and FSA benefits in 2026? Get Clarity today! Schedule a demo to see how our platform simplifies benefits administration and ensures compliance with all new regulations.
