Health Marketplace and Savings Accounts for All Act

Summary

Raises Health Savings Account (HSA) contribution limits by indexing them to an existing Internal Revenue Code “applicable dollar amount,” adds a larger catch-up amount tied to another IRC limit for people 50 and older, and broadens what HSA funds can pay for — including vitamins, dietary supplements, gym/fitness memberships, and wearable fitness trackers. It also reorganizes HSA rules to remove outdated individual-mandate language, creates narrow exceptions for administrative payroll errors and certain pre-account medical expenses, makes technical code fixes across the tax code, and treats HSAs like IRAs for bankruptcy exemption purposes. Creates a new ERISA-based structure called “health marketplace pools” that can be treated as employers only for offering group health plans or group insurance coverage. These pools may offer group plans (including drug-only plans that can cover over-the-counter drugs), set nondiscriminatory membership rules, contract with issuers or self-insure, and provide administrative services — while explicitly not creating employer or joint-employer status for other legal purposes.

• Indexes HSA annual contribution limits to an existing IRC applicable dollar amount and raises the catch-up limit for age 50+ tied to another IRC limit.
• Expands qualified HSA uses to include vitamins, dietary supplements, gym memberships, and wearable fitness trackers as "qualified wellness expenses."
• Allows certain pre-account medical expenses to be treated as HSA-qualified if incurred in the taxable year the account is opened (or the prior year) when established by the tax filing deadline.
• Creates a limited exception for administrative payroll errors on excess HSA contributions if corrected by the tax return due date.
• Treats HSAs like IRAs for bankruptcy exemption purposes for bankruptcy cases filed after enactment.
• Adds a new ERISA framework for "health marketplace pools" that may be treated as employers solely for offering group health or group insurance plans.
• Authorizes pools to offer group plans including drug-only plans that can cover over-the-counter drugs, and permits multiple pools per area and self-insurance or issuer contracting.
• Clarifies that joining or forming a health marketplace pool does not make members employers or joint employers for other legal purposes.
• Makes numerous conforming and technical changes across the tax code and ERISA definitions to implement these reforms.