Health Savings Accounts (HSA): 2025 and 2026 Limits and the New 2026 Rules

The short answer

A health savings account (HSA) is an account you own for medical expenses. If you are covered by a high deductible health plan (HDHP) and meet the other rules, contributions are deductible (or excluded from income if made through your employer), the account grows tax-free, and withdrawals for qualified medical expenses are tax-free. For 2025 you can contribute up to $4,300 (self-only) or $8,550 (family); for 2026, $4,400 or $8,750. Starting in 2026, bronze and catastrophic plans available through an Exchange count as HDHPs.

Who can contribute

Under Publication 969, you are an eligible individual for a month if:

• you are covered by an HDHP on the first day of the month;
• you have no other health coverage, except permitted coverage (such as dental, vision, accident, disability, long-term care, or specific-disease insurance);
• you are not enrolled in Medicare; and
• no one can claim you as a dependent.

Eligibility decides whether you can contribute. Spending the money tax-free depends on a separate test: whether the expense is a qualified medical expense.

2025 and 2026 limits

The limits include your employer's contributions. The age-55 additional contribution goes into your own HSA; if both spouses are 55 or older, each must use their own account. Notice 2026-5 notes that, for 2026, these deductible and out-of-pocket figures do not apply to bronze and catastrophic plans, which are covered by the new rule below.

Married couples and family coverage

• If either spouse has family HDHP coverage, both are treated as having family coverage.
• The family limit is split between the spouses equally unless they agree otherwise; there are no joint HSAs.
• For 2025, if both spouses are 55 or older and eligible, the total can be up to $10,550 ($8,550 plus $1,000 each, with each $1,000 going to that spouse's own HSA).

Partial years: the last-month rule and testing period

If you are eligible on December 1, the last-month rule lets you contribute the full annual amount for that year. But you must stay eligible through the testing period, which runs through December 31 of the following year. If you do not (other than because of death or disability), the extra amount you contributed only because of this rule is included in income for the year you lose eligibility and is subject to a 10% additional tax, figured on Form 8889, Part III.

Medicare

Your contribution limit is zero starting with the first month you are enrolled in Medicare, including months of retroactive Medicare coverage. In the year you enroll, the limit is prorated for the months before enrollment. You can still use the money in your HSA afterward.

Spending HSA money

• Qualified medical expenses: medical care for you, your spouse, and your dependents, not reimbursed by insurance, incurred after the HSA was established.
• Insurance premiums: generally not qualified, except long-term care insurance, COBRA, coverage while receiving unemployment compensation, and (at 65 or older) Medicare and other coverage other than Medigap.
• Other withdrawals: taxable, plus a 20% additional tax unless after disability, age 65, or death.
• No deadline: you do not have to take distributions each year.

Examples (illustrative)

Reporting: Form 8889 and Form W-2

• Form 8889 reports contributions, figures your deduction, and reports distributions. File it with Form 1040 for any year you, your employer, or someone else contributed, your HSA made a distribution, you failed the testing period, or you acquired an interest in an HSA because of the account holder's death.
• Form W-2, box 12, code W shows employer contributions, including your pre-tax cafeteria plan contributions.
• Form 5498-SA (contributions) and Form 1099-SA (distributions) come from the HSA trustee.

New for 2026 under the 2025 tax law

Direct primary care limits (Notice 2026-5). The arrangement must provide only primary care services from primary care practitioners for a fixed periodic fee, with no separate billing. Total DPC fees cannot exceed $150 a month for one person, or $300 a month for an arrangement covering more than one person; the amounts are indexed after 2026. DPC fees paid by an employer, including through salary reduction, cannot also be reimbursed from your HSA.

The contribution limits themselves did not change: people newly eligible through a bronze or catastrophic plan use the same 2026 limits shown above.

HSA vs. health FSA

Being covered by a health FSA or HRA that pays or reimburses your qualified medical expenses generally makes you ineligible to contribute to an HSA; Publication 969 describes exceptions, such as limited-purpose health FSAs and HRAs.

Common mistakes

• Forgetting employer contributions when figuring your own limit.
• Contributing after enrolling in Medicare, including retroactive coverage.
• Losing eligibility during the testing period after a December 1 start.
• Paying expenses from before the HSA was opened.
• Assuming any 2026 marketplace plan qualifies — only bronze and catastrophic plans get the new treatment.