S. 4353

119 S4353 IS: Health Savings Account Expansion Act
 U.S. Senate
 2026-04-21
 text/xml
 EN
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 II  119th CONGRESS  2d Session  S. 4353  IN THE SENATE OF THE UNITED STATES   April 21, 2026   Mr. Marshall  introduced the following bill; which was read twice and referred to the  Committee on Finance    A BILL
To amend the Internal Revenue Code of 1986 to expand eligibility for health savings accounts.
1.
Short title
This Act may be cited as the   Health Savings Account Expansion Act  .
2.
Health savings account eligibility
(a)
In general
Subparagraph (A) of  section 223(c)(1)  of the Internal Revenue Code of 1986 is amended—
(1)
by striking  if—  and inserting  if, as of the 1st day of such month—
(2)
by striking  as of the 1st day of such month  in clause (i),
(3)
by redesignating subclauses (I) and (II) of clause (ii) as items (aa) and (bb), respectively, and by moving such items 2 ems to the right,
(4)
by redesignating clause (ii) as subclause (II) and by moving such subclause 2 ems to the right,
(5)
by striking  such individual  in subclause (II), as so redesignated,
(6)
by striking  such individual is covered  in clause (i) and inserting “such individual—
(I)
is covered
  ,
(7)
by striking the period at the end and inserting  , or , and
(8)
by adding at the end the following new clause:
(ii)
such individual—
(I)
is covered under a government plan, including coverage under the Medicare program under part A, part B, or part C of title XVIII of the Social Security Act, the Medicaid program under title XIX of such Act, the CHIP program under title XXI of such Act or a qualified CHIP look-alike program (as defined in section 2107(g) of such Act), or coverage under  chapter 89  of title 5, United States Code, or
(II)
is a participant in a health care sharing ministry (as defined in section 5000A(d)(2)(B)(ii) without regard to subclause (IV) thereof).
 .
(b)
Conforming amendments
(1)
 Section 223(c)(1)(B)  of the Internal Revenue Code of 1986 is amended by striking  (A)(ii)  and inserting  (A)(i)(II) .
(2)
Section 223(c)(1)(E)(i) of such Code is amended by striking  (A)(ii)  and inserting  (A)(i)(II) .
(c)
Effective date
The amendments made by this section shall apply to taxable years beginning after December 31, 2026.
3.
High deductible health plan requirements
(a)
In general
Paragraph (2) of  section 223(c)  of the Internal Revenue Code of 1986 is amended—
(1)
by striking clause (ii),
(2)
by striking  a health plan—  and all that follows through  which has an annual deductible  and inserting  a health plan which has an annual deductible , and
(3)
by redesignating subclauses (I) and (II) as clauses (i) and (ii), respectively, and by moving such clauses 2 ems to the left.
(b)
Conforming amendments
(1)
Paragraph (2) of  section 223(c)  of the Internal Revenue Code of 1986 is amended by striking subparagraphs (B) and (D) and by redesignating subparagraphs (C), (E), (F), (G), and (H) as subparagraphs (B), (C), (D), (E), and (F), respectively.
(2)
Subparagraph (D) of section 223(c)(2) of such Code, as so redesignated, is amended by striking  paragraph (2)(A)(i)  and inserting  subparagraph (A) .
(c)
Effective date
The amendments made by this section shall apply to taxable years beginning after December 31, 2026.
4.
Payment of health plan and health insurance premiums from HSA
(a)
In general
Paragraph (2) of  section 223(d)  of the Internal Revenue Code of 1986 is amended—
(1)
by striking subparagraph (B),
(2)
by redesignating subparagraphs (C) and (D) as subparagraphs (B) and (C), respectively,
(3)
by striking  Subparagraph (B) shall not apply to any expense  in subparagraph (B), as so redesignated, and inserting  Subparagraph (A) shall not apply to any payment for insurance other than , and
(4)
in subparagraph (B), as so redesignated—
(A)
by striking  or  at the end of clause (iv),
(B)
by striking the period at the end of clause (v) and inserting  , or , and
(C)
by adding at the end the following new clause:
(vi)
a health plan or health insurance coverage described in subsection (c)(1)(A).
 .
(b)
Inclusion of medical care service arrangements as medical expenses
Paragraph (2) of  section 223(d)  of the Internal Revenue Code of 1986, as amended by subsection (a), is further amended by adding at the end the following new subparagraph:
(D)
Inclusion of medical care service arrangements
The term  qualified medical expenses  shall include—
(i)
periodic fees paid to a physician for a defined set of medical services or for the right to receive medical services on an as-needed basis, and
(ii)
amounts prepaid for medical services designed to screen for, diagnose, cure, mitigate, treat, or prevent disease and promote wellness.
 .
(c)
Effective date
The amendments made by this section shall apply to taxable years beginning after December 31, 2026.
5.
Treatment of health care sharing ministries
(a)
In general
Subsection (c) of  section 223  of the Internal Revenue Code of 1986 is amended by adding at the end the following new paragraph:
(6)
Treatment of health care sharing ministries
A health care sharing ministry (as defined in section 5000A(d)(2)(B)(ii) without regard to subclause (IV) thereof) shall not be treated as a health plan or insurance for purposes of this title.
 .
(b)
Effective date
The amendments made by this section shall apply to taxable years beginning after December 31, 2026.
6.
Health care sharing ministry expenses treated as medical care
(a)
In general
 Section 213(d)  of the Internal Revenue Code of 1986 is amended by adding at the end the following new paragraph:
(12)
Health care sharing ministries
Amounts paid for the following expenses with respect to a health care sharing ministry (as defined in section 5000A(d)(2)(B)(ii) without regard to subclause (IV) thereof) shall be treated as amounts paid for medical care:
(A)
Membership fees for such health care sharing ministry.
(B)
The sharing of medical expenses among members.
(C)
Administrative fees of the ministry.
 .
(b)
Effective date
The amendment made by this section shall apply to taxable years beginning after December 31, 2026.
7.
Eligibility for over the counter drugs
(a)
HSAs
(1)
In general
Subparagraph (A) of  section 223(d)(2)  of the Internal Revenue Code of 1986 is amended by adding at the end the following:  Such term shall include an amount paid for medicine or a drug only if such medicine or drug is a prescribed drug (determined without regard to whether such drug is available without a prescription) or is insulin. .
(2)
Conforming amendment
Paragraph (2) of section 223(d) of such Code is amended by striking subparagraph (C) and by redesignating subparagraphs (D) and (E) as subparagraphs (C) and (D), respectively.
(b)
Archer MSAs
 Section 220(d)(2)(A)  of the Internal Revenue Code of 1986 is amended by adding at the end the following:  Such term shall include an amount paid for medicine or a drug only if such medicine or drug is a prescribed drug (determined without regard to whether such drug is available without a prescription) or is insulin. .
(c)
Effective date
The amendments made by this section shall apply to taxable years beginning after December 31, 2026.