ACCESS Act Swaps Cost-Sharing for HSAs in Health Plans Starting 2026: New Rules and Debit Card Requirements

The "Affordable Care and Comprehensive Economic Support through Savings Act" (ACCESS Act) is shaking up how some people pay for healthcare. Instead of getting reduced costs at the doctor's office, you might get money deposited into a Health Savings Account (HSA). Here's the breakdown:

Swapping Subsidies for Savings

This bill changes the game for people who qualify for cost-sharing reductions (CSRs) – those subsidies that lower your out-of-pocket costs like deductibles and copays. Starting January 1, 2026, if you're eligible for CSRs and pick a high-deductible health plan through the insurance exchange, you won't get those lower costs directly. Instead, the insurance company will put money into an HSA for you. (SEC. 2)

• How it works: The amount you'd save annually with CSRs gets divided by 12 and deposited monthly into your HSA. The government then reimburses the insurance company for these deposits. (SEC. 2)
• Example: Imagine you're a single mom working part-time at a coffee shop. You qualify for a plan that would normally reduce your out-of-pocket costs by $1,200 a year. Under this bill, you'd get $100 a month ($1,200 / 12) deposited into an HSA instead.

The Debit Card Detail

Here's a catch: during the months you receive these HSA deposits, you must use a "qualified medical debit card" to spend the money. This is to make sure the funds go towards healthcare expenses. (SEC. 2)

• Potential hassle: This could be an extra step, especially if you're used to managing your healthcare costs differently.

High-Deductible or Bust?

The bill also says that if you're eligible for these HSA contributions, insurance companies offering silver-level plans (which typically have moderate deductibles) must also offer a high-deductible option. (SEC. 2)

• Trade-off: High-deductible plans usually have lower monthly premiums, but you pay more out-of-pocket before insurance kicks in. This could be a good deal if you're generally healthy, but a riskier bet if you have ongoing health needs.

Tax Time Tangle

Those HSA deposits are treated as advance payments of the health coverage tax credit. If your income changes during the year, the credit gets adjusted, and you might have to pay some of that money back. (SEC. 2)

• Example: Let's say you get a raise mid-year, and your income goes up significantly. You might end up owing money at tax time because you received more HSA contributions than you were ultimately eligible for.

Getting the Word Out

Starting in 2026, insurance companies and exchanges have to tell people about this HSA option and how to set one up. (SEC. 2). The funding for the cost-sharing reduction payments, and for these HSA contributions, has been permanently appropriated by Congress, beginning after Dec 31, 2025. (SEC. 2).

The Big Picture

This bill represents a shift from direct cost-sharing assistance to a savings-based approach. It could give some people more control over their healthcare spending and potential tax benefits. However, it also adds complexity and could make things harder for those who rely on immediate cost reductions to afford care. The requirement to use a special debit card and the potential for owing money back at tax time are important details to consider.