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Under the ACA, can I still have an individual HDHP and an HSA?

Author: Louise Norris | Date Posted: March 17, 2026

You can still have an individual high-deductible health plan and a health savings account

Under the Affordable Care Act, can I still have an individual HDHP and a health savings account (HSA)?

Yes, you can still have an HDHP (high-deductible health plan) that will allow you to contribute to an HSA, as there are HDHPs in the ACA-compliant individual market in all areas of the country.

Starting with the 2026 plan year, there are significantly more HDHPs available in the individual market nationwide, due to changes made by the “One Big Beautiful Bill.” Under that law, all Bronze and Catastrophic plans purchased in the health insurance Marketplace/exchange are now considered HDHPs, allowing enrollees to contribute to an HSA.¹

(Note that the IRS is also considering off-exchange Bronze and Catastrophic plans to be HDHPs, as long as an identical version of the plan is sold in the exchange, or if the enrollee "has no reason to believe that the Bronze or Catastrophic plan is not available on an Exchange.")²

This has greatly increased the number of HDHPs available to Marketplace enrollees, and the number of Marketplace enrollees who are eligible to make HSA contributions. For example:

Dallas had two HDHPs available in 2025. Both of them were Bronze plans, but there were 28 other Bronze plans available in Dallas that weren’t considered HDHPs in 2025.³
In 2026, there are 33 Bronze plans available in Dallas, and all of them are HDHPs, due to the definition change in the OBBBA.⁴

Eligibility for Catastrophic plans, which are also HDHPs as of 2026, has been expanded so that more people have the option to purchase these plans. For people who are 30 or older, hardship exemptions are necessary to enroll in a Catastrophic plan, but hardship exemptions are now available if household income is more than 250% of the federal poverty level. But Catastrophic plans continue to be ineligible for premium subsidies in the Marketplace,⁵ so they are unlikely to be an attractive option for people earning no more than 400% of the poverty level, since those enrollees can qualify for subsidies if they pick a metal-level plan instead.

Before the rule change that newly defined all Bronze and Catastrophic Marketplace plans as HDHPs, the number of available HDHPs in the Marketplace had been declining, and enrollment in Marketplace HDHPs had also been declining. HHS noted in 2023 that while 8% of Marketplace enrollees selected HDHPs in 2019, that had dropped to 5% by 2022. And while HDHPs had accounted for 7% of all the available Marketplace plans in 2019, they accounted for just 3% of available plans in 2023.⁶

In 2025, when only a small fraction of Bronze plans were HDHPs, about 31% of Marketplace enrollees selected Bronze plans.⁷ In 2026, all Bronze Marketplace plans are HDHPs, and Bronze plan enrollment increased as people looked for ways to reduce the premium increases that stemmed from the expiration of the federal subsidy enhancements at the end of 2025.

There have been some changes over time in terms of how HDHPs have been viewed by federal regulators. Starting in 2019, HHS began considering ways to encourage more insurers to offer HDHPs, and “exploring how to use plan display options on HealthCare.gov to promote the availability of HDHPs to applicants.”⁸

For HSA-eligible plans in 2021, HealthCare.gov displayed the plan with a blue banner that read, “Eligible for a health savings account.” This was a more prominent notice than the one that was used prior to 2020, but HealthCare.gov no longer uses this differential display.

And in the regulation that limits the number of non-standardized plans (including HDHPs, which are not standardized on HealthCare.gov) that insurers would be able to offer via HealthCare.gov as of 2024, HHS said “We believe the fact that there is a steadily decreasing number of issuers choosing to offer these plans [HDHPs], as well as a steadily decreasing number of consumers choosing to enroll in these plans, reflects both issuer and consumer preference evolving away from these types of plan offerings.”

However, consumers have continued to enroll in Bronze plans in large numbers, and as noted above, all of those plans will be considered HDHPs in 2026. Of the 24.3 million people who enrolled in Marketplace plans during the open enrollment period for 2025 coverage, nearly 7.3 million selected Bronze plans.⁹

If you're shopping the exchange, you can filter the available plans to only show HSA-eligible options, if that's your preference. HSA-qualified plans often have “HSA” in the plan name, but that's not always the case. So using that filter tool when you're comparing plans is a good way to make sure you're not overlooking any plans. As noted above, all Bronze and Catastrophic Marketplace plans are HDHPs as of 2026. But depending on where you live, you might also see some HDHPs at the Silver or Gold metal level.

Do HDHPs have higher deductibles than other plans?

Now that all Bronze and Catastrophic Marketplace plans are considered HDHPs, it's true that HDHPs do include the plans with the highest deductibles (this is referring to the individual market, rather than the employer-sponsored market).

But HDHPs that aren't Bronze or Catastrophic Marketplace plans are required to follow strict IRS rules that limit their maximum out-of-pocket costs to a lower level than the limits that apply to non-HDHPs.¹⁰

For non-HDHPs as well as Marketplace Bronze and Catastrophic plans, the highest allowable out-of-pocket exposure in 2026 is $10,600 for an individual, including the deductible, coinsurance, and any other in-network out-of-pocket costs. For HDHPs other than Bronze and Catastrophic Marketplace plans, the maximum out-of-pocket limit in 2026 is $8,500 for an individual.²

The IRS has always limited out-of-pocket caps for HDHPs. Before 2014, there was no rule for how high out-of-pocket limits could be for non-HDHPs, but the ACA changed that, starting in 2014. That year, the maximum out-of-pocket limit for HDHPs was the same as the maximum out-of-pocket limit for all plans regulated by the ACA ($6,350 for an individual).¹¹ But since then, the out-of-pocket limit for non-HDHPs (set by HHS each year) has generally grown faster than the out-of-pocket limit for HDHPs (set by the IRS each year).

For 2027 coverage, CMS has proposed much higher limits on out-of-pocket costs for Catastrophic plans (up to $15,600), as well as allowing Bronze plans to have out-of-pocket limits above the $12,000 cap that will apply to other plans in 2027.¹² So it's possible that some HDHPs in 2027 could have significantly higher out-of-pocket exposure.

How the ACA changed HDHPs

The Affordable Care Act did change a couple of rules regarding HSAs, effective in 2011:

Before 2011, the penalty for HSA withdrawals for non-medical purposes was 10%. But it doubled to 20% on January 1, 2011.¹³ Account holders can avoid this fee by either using their HSA funds for medical expenses OR waiting to withdraw funds until they're at least 65. After that, income tax applies to withdrawals for non-medical purposes, but there's no penalty.¹⁴
Before 2011, HSA funds could be used for over-the-counter medicines. But under the ACA, from 2011 through 2019, OTC medicines could only be purchased with HSA funds if a doctor prescribed them. That changed in 2020, however, with the Coronavirus Aid, Relief, and Economic Security Act (CARES Act), which permanently relaxed these rules, retroactive to January 1, 2020. Under the CARES Act, HSA funds can be used to pay for OTC medications, and also menstrual products, without a prescription.

Under ACA regulations, HSA-qualified plans (like all plans) must cover preventive care with no cost-sharing and without requiring the insured to meet the deductible first. Under the IRS's HSA regulations, no other claims can be paid by the health plan before the deductible is met (although the IRS expanded the rules in 2019, to allow more services to be considered preventive care under HSA-qualified plans, and paid by the insurer pre-deductible). These two sets of rules (for ACA-compliant coverage and for HSA-eligible coverage) have co-existed well since 2014, when all new HSA-qualified plans have also been ACA-compliant.

But state health insurance rules do present a potential conflict with IRS rules for HDHPs. States can require additional benefits, going above and beyond the ACA's reforms. If a state requires benefits that exceed the IRS limits for HDHPs, however, it can result in the plans losing their HDHP status.

An example of this is pre-deductible coverage for male contraceptives. A few states have mandates requiring health plans to cover male contraception pre-deductible, but the IRS does not consider male contraception to be preventive care. To address the issue, the IRS provided transitional relief, through 2019, to anyone covered on a plan that would otherwise be an HDHP, but that included pre-deductible coverage for male contraception.

The idea was to give states time to revise their laws to exempt HDHPs from the male contraceptive mandates, without penalizing enrollees in the meantime. (In general, the statutes in the states that require vasectomy coverage do now include exemptions for HDHPs; for example, the Illinois statute requiring vasectomy coverage clarifies that its provisions “do not apply to coverage of voluntary male sterilization procedures to the extent such coverage would disqualify a high-deductible health plan from eligibility for a health savings account.”)¹⁵

As a result of the COVID-19 pandemic, the IRS also relaxed the rules to allow HDHPs to pay for COVID-19 testing and treatment pre-deductible without compromising the plan's HSA eligibility through the end of 2024. To clarify, all health plans were required to pay for the cost of COVID testing during the public health emergency, which ended in May 2023. After that, HDHPs had the option to continue to cover COVID testing and treatment pre-deductible without losing HDHP status, but only through 2024.

How do standardized plan rules affect HDHP availability?

There was initially some worry about HSA-qualified plans being driven out by standardized plans, but that has not come to pass. HHS introduced optional standardized plans on HealthCare.gov starting in 2017, and included a Bronze HDHP in the standardized plan designs for 2018. But HHS temporarily did away with the standardized plan designs as of 2019.

Standardized plans returned to HealthCare.gov as of the 2023 plan year, but HHS clarified that they were not including a standardized HDHP, and would instead allow HDHPs to simply be part of the suite of non-standardized plans that insurers could offer. But since 2024, HHS has limited the number of non-standardized plans that insurers can offer through HealthCare.gov.¹⁶ And they note that "while we acknowledge that this limit may affect HSA-eligible HDHP offerings, we do not believe that an exception to the limit is warranted for these plan offerings as there has been a steady decrease in both the proportion of HSA-eligible HDHP offerings and enrollment in these plan offerings (especially at the silver, gold, and platinum metal levels) over the past several years."

For 2025 and future years, HHS further limited the number of non-standardized plans that insurers can offer through HealthCare.gov.¹⁷ In finalizing that rule, HHS noted that they "have not included an HSA-eligible HDHP in these sets of plan designs due to decreased enrollment in these plans in the last several plan years, which suggests they may be less competitive and in-demand than traditional health insurance plans."

For 2027, however, CMS has proposed discontinuing standardized plans and no longer placing limits on the number of non-standardized plans that carriers can offer.¹⁸

And the rule changes under the “One Big Beautiful Bill Act,” allowing all Bronze and Catastrophic Marketplace plans to be considered HDHPs, greatly increased the number of HDHPs available in the Marketplace nationwide.

Embedded individual out-of-pocket maximums

One market-wide change that took effect in 2016 requires that all family plans include embedded individual out-of-pocket maximums that don't exceed whatever HHS has set as the individual out-of-pocket maximum for that year¹⁹ (so in 2025, plans with multiple family members must have individual out-of-pocket maximums that don't exceed $9,200).

Embedded individual out-of-pocket maximums were already the norm on plans that weren't HSA-qualified, but many HSA-qualified plans traditionally utilized an aggregate family deductible and out-of-pocket maximum when more than one person was covered by the plan, so the impact of the rule was stronger for HDHPs.¹⁹ So for example, an HDHP with a $12,000 family deductible used to be able to require the full $12,000 deductible to be met before services were covered, even if just one family member needed medical care. Those plans must now embed an individual out-of-pocket maximum on all policies that have more than one covered family member, and the individual out-of-pocket maximum cannot exceed the maximum individual out-of-pocket exposure that HHS sets for all plans for the year.

Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written hundreds of opinions and educational pieces about the Affordable Care Act for healthinsurance.org.