Health Savings Accounts Face New Abortion Restrictions Starting 2026

The "Protecting Life in Health Savings Accounts Act" changes how people can use their Health Savings Accounts (HSAs) and similar tax-advantaged accounts. Starting after December 31, 2025, these accounts cannot be used to pay for abortions, except in specific situations.

No HSA for Most Abortions

The core change is straightforward: HSAs, Archer MSAs, health flexible spending arrangements, and other similar accounts will no longer cover abortion costs for most people. This means individuals will have to pay out-of-pocket for these procedures, which can be a significant expense.

Exceptions and Paperwork

There are exceptions, but they come with a catch. The bill allows HSA funds to be used for abortions in cases of rape, incest, or when the woman's life is at risk. However, a physician must certify in writing that one of these conditions applies. This certification requirement (see SEC. 2) adds an extra step and potential barrier for those seeking an abortion under these circumstances.

For example, consider someone who uses their HSA to manage all their healthcare expenses. If they need an abortion and it doesn't fall under the exceptions, they'll suddenly face a large, unexpected bill they can't use their HSA for. They'll have to find other funds, which could be difficult, especially for those with lower incomes who rely on HSAs to make healthcare affordable.

Real-World Impact

This law directly impacts anyone using HSAs or similar accounts who might need an abortion. It adds a layer of financial and administrative complexity to an already difficult situation. The physician certification requirement, while intended to define the exceptions, could also create delays or hurdles in accessing care, depending on how readily available doctors are to provide this certification.

The law also raises questions about enforcement. How will the IRS or account administrators know if an HSA withdrawal was used for an abortion that doesn't meet the exceptions? This opens up potential issues of privacy and compliance.

The "Protecting Life in Health Savings Accounts Act" represents a significant shift in how these accounts can be used, directly affecting reproductive healthcare choices and potentially creating financial burdens for those seeking abortions.