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Health Savings Account Expansion Act
To amend the Internal Revenue Code of 1986 to expand eligibility for health savings accounts.
Summary
This bill amends the Internal Revenue Code to expand eligibility for health savings accounts (HSAs) to individuals covered under government health programs, including Medicare, Medicaid, and CHIP, as well as members of health care sharing ministries. It modifies the rules governing high deductible health plans and allows HSA funds to be used to pay for health insurance premiums and health care sharing ministry expenses. The bill also expands the definition of qualified medical expenses covered by HSAs to include periodic physician fees, prepaid wellness services, and over-the-counter drugs if they are prescribed or if the drug is insulin. Additionally, health care sharing ministries are treated as distinct entities rather than health plans for tax purposes. These changes are effective for tax years beginning after December 31, 2026.
AI-generated plain-language summary of the bill text — neutral, and may be imperfect. See the full text below for the exact wording.
Sponsor (1)
- Sen. Marshall, Roger [R-KS] (R-KS)
Money behind the sponsor
Top reported contributors to Roger Marshall’s campaign committee (2024 cycle) — who funds the bill’s sponsor, not a claim about this bill. Data from FEC.
- NULL $46,314
- PYRAMID SOUND $19,800
- GROWITZ EQUITY $13,200
- SPECCHEM $13,200
- ONYX EQUITY PARTNERS $13,200
Organizations whose employees gave the most — itemized individual contributions grouped by the donor’s reported employer (FEC Schedule A). Full finance for Roger Marshall → · Outside spending →
Actions (2)
- Apr 21, 2026 Read twice and referred to the Committee on Finance. · senate
- Apr 21, 2026 Introduced in Senate
Similar bills (6)
Bills with similar text or summary — includes reintroductions across Congresses. Ranked by semantic similarity of the bill text (computed locally); a neutral discovery aid, not a claim the bills are duplicates.
Full text
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.
Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the “Health Savings Account Expansion Act”.
SEC. 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.
SEC. 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.
SEC. 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.
SEC. 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.
SEC. 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.
SEC. 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. <all>
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