Starting in 2026, people who enroll in Bronze or Catastrophic plans through the ACA marketplace can contribute to a health savings account (HSA), even if their plan does not meet the IRS definition of a high-deductible health plan. Previously, HDHP enrollment was the only way to access an HSA. This change makes more than seven million people newly eligible for HSAs, marking the largest expansion of HSA access to date.
For 2026 coverage, nearly 9.2 million marketplace enrollees selected Bronze plans, up from roughly 30% to nearly 40% of enrollees, as many buyers shifted to lower premiums when enhanced federal subsidies ended.
An HSA offers three tax advantages: no taxes on contributions (in most states), no taxes on account growth, and no taxes on withdrawals for qualified healthcare expenses. A self-employed person who contributes $1,000 to an HSA avoids the need to earn an extra $100 to $200 (depending on tax rate) to pay the same healthcare bill from ordinary income. Unlike some accounts, HSA balances do not expire and can roll over year to year.
An HSA cannot pay insurance premiums, so it does not directly address rising premium costs that many Bronze-plan enrollees face.
Open enrollment for 2027 marketplace coverage runs November 1 through December 15 in most states. Plan information will note whether HSAs are permitted, though insurers generally do not promote this fact and most state and federal exchange sites are only beginning to include HSA guidance.
For 2027, individuals can contribute up to $4,500 to an HSA, or $9,000 for family coverage, plus an extra $1,000 if age 55 or older. Contributions reduce taxable income. Qualified expenses include telehealth services and, new this year, direct primary care arrangement fees up to an IRS monthly limit. Account holders can reimburse themselves for qualified expenses incurred years earlier, allowing the balance to grow tax-free in the meantime. Balances can be invested through a qualified custodian, similar to 401(k) options.