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

Author: Louise Norris | Date Posted: September 3, 2025

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 nearly all areas of the country.

Starting with the 2026 plan year, there will be 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 will be considered HDHPs as of plan year 2026, allowing enrollees to contribute to an HSA.¹

This will greatly increase the number of HDHPs available to Marketplace enrollees, and the number of Marketplace enrollees who are eligible to make HSA contributions. For example, Dallas has two HDHPs available in 2025. Both of them are Bronze plans, but there are 28 other Bronze plans available in Dallas that aren’t considered HDHPs in 2025.² Starting in 2026, all of those plans will be treated as HDHPs due to the definition change in the OBBBA.

Eligibility for Catastrophic plans will continue to be limited to people under age 30 or people with a hardship exemption obtained from the Marketplace. Catastrophic plans will also continue to be ineligible for premium subsidies in the Marketplace.³

Although there are currently some HDHPs in the Marketplace in most areas, fewer people are enrolling in these plans in recent years, and there are not as many HDHPs available as there were a few years ago. 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 2023.⁴

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.”⁵

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.⁶

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. And again, the range of available Marketplace HDHPs will expand greatly as of the 2026 plan year, when all Bronze and Catastrophic plans will be considered HDHPs.

Plans with very high deductibles (which have never been HSA-qualified HDHPs) are not allowed under the ACA because the ACA sets annual limits for out-of-pocket expenses. So for example, while it was possible to buy a plan with a $15,000 individual deductible prior to 2014, those plans are no longer sold. (The highest allowable out-of-pocket exposure in 2025 is $9,200 for an individual, including the deductible, coinsurance, and any other in-network out-of-pocket costs.⁷ This upper limit on out-of-pocket costs will increase to $10,600 in 2026).⁸ much the way the ACA now imposes such limits on all plans.

In 2014, the first year that the ACA began limiting out-of-pocket exposure, 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.⁹ (Those limits have since diverged, as they are indexed with different formulas). So while the ACA prevented new plans from having extremely high deductibles and out-of-pocket exposure, the ACA’s requirements worked well with the regulations for HSAs and HDHPs.

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, 2011.¹⁰ 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.¹¹
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.”)¹²

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 out-of-pocket limits for HDHPs compare to other plans?

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.

In 2014, the out-of-pocket maximums for individual health plans under the ACA were the same as the limits on HDHPs: $6,350 for individuals and $12,700 for families.¹³ 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).

The maximum out-of-pocket limit for non-HDHPs in 2025 is $9,200 for individuals and $18,900 for families.¹⁴ For HSA-qualified plans, the out-of-pocket limits are lower, at $8,300 for an individual and $16,600 for a family.¹⁵

For 2026, the maximum allowable out-of-pocket cap for non-HDHPs – and for Bronze and Catastrophic Marketplace plans, which will be considered HDHPs – will be $10,600 for an individual, and $21,200 for family coverage.¹⁶ For HDHPs other than Bronze and Catastrophic Marketplace plans, those limits will be $8,500 and $16,600, respectively.¹⁷

Clearly, HSA-qualified high-deductible plans fit easily within the coverage rules established by the ACA, in terms of out-of-pocket limits and required benefits. But while they were among the lowest-priced options on the market in the early years of ACA implementation, that has begun to change as the maximum allowable out-of-pocket exposure on non-HDHPs has climbed quite a bit higher than the maximum allowable out-of-pocket exposure on HDHPs.

Higher out-of-pocket costs generally go hand-in-hand with lower premiums, which means that there tend to be several plans in most markets that are now priced lower than the available HDHPs. But by and large, HDHPs do continue to be among the lower-priced options in each area. And starting with the 2026 plan year, even the lowest-priced Marketplace Bronze and Catastrophic plans will be considered HDHPs, allowing enrollees to contribute to an HSA.

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.¹⁸ 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 has further limited the number of non-standardized plans that insurers can offer through HealthCare.gov.¹⁹ 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."

But the rule changes under the “One Big Beautiful Bill Act,” allowing all Bronze and Catastrophic Marketplace plans to be considered HDHPs, greatly increases 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 year²⁰ (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.²⁰ So for example, an HDHP with a $10,000 family deductible used to be able to require the full $10,000 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.²¹

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.