Congress tightens HSA rules: income caps, 2-year limits, fee oversight
H.R. 6183 — To amend the Internal Revenue Code of 1986 to reform certain rules related to health savings accounts. · Filed by Lloyd Doggett (D-TX) · 1 cosponsor · Introduced Nov 20, 2025 · Referred to committee
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What it does
This bill modifies health savings accounts (HSAs) by adding income limits for contributions, restricting reimbursements to expenses incurred within the past 2 years, requiring medical substantiation for distributions, excluding spa/beauty treatments and exercise equipment over $500, imposing an excise tax on excessive HSA fees charged by trustees, and requiring reporting of HSA earnings and fee information. The changes take effect for tax years and distributions after December 31, 2025.
Why we flagged it
The bill is a comprehensive restructuring of HSA rules, mixing consumer protections (fee caps, transparency) with new restrictions (income limits, reimbursement windows, substantiation) that reshape how HSAs function as savings vehicles.
What the text implies
- The 2-year reimbursement window (Section 4) may force HSA holders to choose between immediate reimbursement or forfeiting the deduction, effectively converting HSAs from long-term savings vehicles to shorter-term accounts and reducing their appeal as retirement health-care funding tools.
- Income limits (Section 3) phase out HSA deductibility for higher earners, potentially reducing HSA adoption among affluent workers and shifting the account's user base downward—a policy choice not explicitly framed as income redistribution but functionally regressive in effect.
The full analysis lists 5 implications of this text.
Who stands to gain
HSA trustees and financial institutions (fee regulation may reduce competitive pressure and standard; Lower-income HSA users (fee caps and transparency reduce costs); Health insurance carriers (HSA restrictions may increase reliance on traditional insurance)