Telehealth Safe Harbor: Permanent Law, HDHP Rules, and HSAs

A high-deductible health plan can cover telehealth visits before you meet your deductible without costing you your HSA eligibility. The telehealth safe harbor for HSAs, first enacted as a temporary pandemic measure in 2020, became permanent federal law on July 4, 2025, when the One Big Beautiful Bill Act was signed. Section 71306 of that act amended the Internal Revenue Code so that offering free or reduced-cost virtual care no longer disqualifies a plan from HDHP status. The change is retroactive to plan years beginning after December 31, 2024, and carries no expiration date.¹

Why This Rule Exists

An HSA-qualified plan is built around a bargain: you pay for most care out of pocket until you hit the deductible, and in exchange contributions to your HSA get a triple tax break. To protect that structure, the tax code generally bars HDHPs from covering non-preventive services before the deductible is met.²

Without a special exception, even a $0-copay video visit for a sore throat would count as first-dollar coverage and blow up the plan’s HDHP qualification. That is the problem the safe harbor solves.

From Temporary Fix to Permanent Law

The CARES Act, passed in March 2020, added a temporary provision letting HDHPs cover telehealth with no deductible. The original exception ran through plan years beginning on or before December 31, 2021.³ Congress extended it twice through appropriations bills, with the final extension covering plan years beginning before 2025.

That last extension expired on December 31, 2024, leaving calendar-year plans briefly exposed. The One Big Beautiful Bill Act closed the gap by making the safe harbor permanent and applying it retroactively to plan years beginning after December 31, 2024.¹ The amended statute now states plainly that a plan does not lose its HDHP status because it offers telehealth benefits without a deductible.² Employers who scaled back telehealth coverage during early 2025 can reinstate it either retroactively or on a going-forward basis.

The practical effect is that plan sponsors no longer have to track legislative renewals every couple of years, and enrollees no longer have to worry that a video visit might quietly cost them a year of HSA contributions.

What Counts as Telehealth Under the Safe Harbor

IRS Notice 2026-05 ties the definition of qualifying telehealth to the list of services payable by Medicare, which the Department of Health and Human Services publishes each year. If a service is on that list, your HDHP can cover it pre-deductible with no risk to your HSA eligibility. For services not on the list, the IRS applies the general principles Medicare uses to define telehealth, which broadly cover real-time audio-video consultations and certain remote patient monitoring.¹

In everyday terms, that covers the virtual care most people actually use:

Primary care consultations
Specialist evaluations
Urgent care screenings for acute illness
Therapy and psychiatric appointments
Medication management check-ins

Delivery can be live video, phone call, or secure messaging with a licensed provider.

What the Safe Harbor Does Not Cover

The IRS drew a clear line. The safe harbor applies to the telehealth service itself, not to anything furnished in connection with it.¹ If a doctor prescribes medication during a video visit, the prescription still runs through your normal deductible. The same applies to lab work or medical equipment ordered as a follow-up. Your plan can cover the virtual consultation at $0, but the pharmacy bill or the lab charge is a separate item subject to standard cost-sharing.

Some medications get pre-deductible coverage through separate exceptions, not through the telehealth rule. The IRS lets HDHPs cover a specific list of items used to manage chronic conditions before the deductible, including insulin, statins, ACE inhibitors for heart failure or diabetes, blood pressure monitors for hypertension, inhalers for asthma, SSRIs for depression, and glucometers and A1c testing for diabetes. These items qualify only when prescribed for the specific chronic condition on the list.⁴ Insulin has its own permanent statutory safe harbor: HDHPs can cover it pre-deductible in all forms, regardless of diagnosis.²

How the Telehealth Carve-Out Fits With Other Pre-Deductible Coverage

Telehealth is one of several categories that get statutory permission to sit outside the deductible. The others matter for judging whether a plan is a fully qualified HDHP overall.

Preventive care. Annual physicals, immunizations, and screenings can be covered at no cost before you meet the deductible. This exception has existed since HSAs were created in 2003.²
Chronic condition management. The items and services listed in IRS Notice 2019-45 can be covered pre-deductible when prescribed to keep a chronic condition from worsening.⁴
Insulin. All dosage forms and types are permanently exempt from the deductible requirement.²
Surprise billing protections. Emergency out-of-network coverage required under federal surprise billing rules does not count against the deductible requirement for HDHP qualification.²

A plan can stack all of these. Preventive care, chronic-condition drugs, insulin, and telehealth can all be covered from day one, and the plan remains a qualified HDHP paired with your HSA.

What This Means for You

If you are enrolled in an HSA-qualified plan, you can use virtual visits for covered telehealth services without worrying about the deductible or your ability to keep contributing to your HSA. If your employer paused or scaled back pre-deductible telehealth during the 2025 gap, the coverage can be restored, and the retroactive effective date protects contributions you made during that window. And unlike the previous versions of this rule, there is no next expiration date to plan around.

1
Internal Revenue Service. Notice 2026-05
2
Office of the Law Revision Counsel. 26 USC 223 – Health Savings Accounts
3
U.S. Congress. Public Law 116-136 – CARES Act, Section 3701
4
Internal Revenue Service. Notice 2019-45