H.R. 6183 makes several significant changes to the rules governing health savings accounts (HSAs), effective for tax years and distributions after December 31, 2025. The bill eliminates a current exception allowing penalty-free HSA withdrawals for certain non-medical expenses, and it imposes new income limits on HSA contributions—reducing the deductible amount for higher-income individuals starting at $200,000 to $300,000 depending on filing status. The legislation also adds new restrictions on HSA use, including a requirement that medical expense reimbursements be made within two years of when the expense was paid, a substantiation requirement to prove expenses are medically necessary, and exclusions for spa treatments and exercise equipment over $500 annually. Additionally, the bill creates an excise tax on excessive HSA fees charged by financial institutions and requires trustees to report earnings yields on HSA cash balances to help account holders compare their returns to national averages. These reforms primarily affect individual HSA users, especially higher-income earners, and HSA trustee institutions.
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