I 
119TH CONGRESS 
1ST SESSION H. R. 6183 
To amend the Internal Revenue Code of 1986 to reform certain rules related 
to health savings accounts. 
IN THE HOUSE OF REPRESENTATIVES 
NOVEMBER 20, 2025 
Mr. DOGGETT introduced the following bill; which was referred to the 
Committee on Ways and Means 
A BILL 
To amend the Internal Revenue Code of 1986 to reform 
certain rules related to health savings accounts. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. REFERENCES. 
Except as otherwise expressly provided, whenever in 
this Act an amendment or repeal is expressed in terms 
of an amendment to, or repeal of, a section or other provi-
sion, the reference shall be considered to be made to a 
section or other provision of the Internal Revenue Code 
of 1986. 
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SEC. 2. REPEAL OF EXCEPTION TO REQUIREMENT THAT 
PENALTY-FREE 
DISTRIBUTIONS 
BE 
FOR 
QUALIFIED MEDICAL EXPENSES. 
(a) IN GENERAL.—Section 223(f)(4) is amended by 
striking subparagraph (C). 
(b) EFFECTIVE DATE.—The amendment made by 
this section shall apply to distributions made after Decem-
ber 31, 2025. 
SEC. 3. INCOME LIMITATION ON DEDUCTIBLE CONTRIBU-
TIONS TO HEALTH SAVINGS ACCOUNTS. 
(a) IN GENERAL.—Section 223(b) is amended by 
adding at the end the following new paragraph: 
‘‘(9) LIMITATION
BASED
ON
MODIFIED
AD-
JUSTED GROSS INCOME.— 
‘‘(A) IN GENERAL.—The amount otherwise 
allowable as a deduction under subsection (a) 
shall be reduced (but not below zero) by an 
amount which bears the same ratio to the 
amount so allowable (determined without re-
gard to this paragraph) as— 
‘‘(i) the amount (if any) by which the 
taxpayer’s modified adjusted gross income 
exceeds the applicable income threshold, 
bears to 
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‘‘(ii) $40,000 ($20,000 in the case of 
a married individual filing a separate re-
turn). 
‘‘(B) APPLICABLE INCOME THRESHOLD.— 
For purposes of this paragraph, the term ‘ap-
plicable income threshold’ means— 
‘‘(i) in the case of a joint return or 
surviving spouse (as defined in section 
2(a)), $300,000, 
‘‘(ii) in the case of a head of house-
hold, $250,000, 
‘‘(iii) in the case of a married indi-
vidual filing a separate return, $150,000, 
and 
‘‘(iv) in any other case, $200,000. 
‘‘(C) MODIFIED
ADJUSTED
GROSS
IN-
COME.—For purposes of this paragraph, the 
term ‘modified adjusted gross income’ means 
adjusted gross income determined without re-
gard to this section and sections 911, 931, and 
933.’’. 
(b) TREATMENT OF NON-DEDUCTIBLE CONTRIBU-
TIONS.— 
(1) 
RULES
FOR
DISTRIBUTION.—Section 
223(f)(2) is amended is amended by striking ‘‘shall 
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be included in the gross income of such beneficiary.’’ 
and inserting ‘‘shall be included in the gross income 
of the beneficiary as provided in section 72. Rules 
similar to the rules of section 408(d)(2) shall apply 
for purposes of the preceding sentence.’’. 
(2) COORDINATION WITH EXCISE TAX ON EX-
CESS
CONTRIBUTIONS.—Section 
4973(g)(1) 
is 
amended by inserting ‘‘(determined without regard 
to section 223(b)(9))’’ after ‘‘section 223’’. 
(c) PAYROLL TAXES.— 
(1) FICA.—Section 3121(a) is amended by 
striking ‘‘or’’ at the end of paragraph (22), by strik-
ing the period at the end of paragraph (23) and in-
serting ‘‘; or’’, and by inserting afer paragraph (23) 
the following new paragraph: 
‘‘(24)(A) for purposes of section 3101, any pay-
ment excludable from the employee’s gross income 
under section 106(d), and 
‘‘(B) for purposes of any other provision of this 
chapter (including section 3102), any payment made 
to or for the benefit of an employee if at the time 
of such payment it is reasonable to believe that the 
employee will be able to exclude such payment from 
income under section 106(d).’’. 
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(2) 
RAILROAD
RETIREMENT.—Section 
3231(e)(11) is amended to read as follows: 
‘‘(11)(A) for purposes of section 3201, any pay-
ment excludable from the employee’s gross income 
under section 106(d), and 
‘‘(B) for purposes of any other provision of this 
chapter (including section 3202), any payment made 
to or for the benefit of an employee if at the time 
of such payment it is reasonable to believe that the 
employee will be able to exclude such payment from 
income under section 106(d);’’. 
(d) EFFECTIVE DATE.— 
(1) IN
GENERAL.—Except as otherwise pro-
vided in this subsection, the amendments made by 
this section shall apply to taxable years beginning 
after December 31, 2025. 
(2) PAYROLL TAXES.—The amendments made 
by subsection (c) shall apply to payments made after 
December 31, 2025. 
SEC. 4. HEALTH SAVINGS ACCOUNT REIMBURSEMENT OF 
MEDICAL EXPENSES LIMITED TO 2 YEARS. 
(a) IN GENERAL.—Section 223(d)(2) is amended by 
adding at the end the following new subparagraph: 
‘‘(E) REIMBURSEMENTS
LIMITED
TO
YEARS.—An amount paid or distributed from a 
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health savings account to reimburse the account 
beneficiary for a qualified medical expense shall 
not be treated as used to pay a qualified med-
ical expense unless such distribution is made 
not later than 2 years after the date on which 
such reimbursed qualified medical expense was 
paid.’’. 
(b) EFFECTIVE DATE.—The amendment made by 
this section shall apply to amounts paid or distributed 
from a health savings account after December 31, 2025. 
SEC. 5. REQUIREMENT TO SUBSTANTIATE DISTRIBUTIONS 
FROM HEALTH SAVINGS ACCOUNTS THAT 
ARE FOR QUALIFIED MEDICAL EXPENSES. 
(a) IN GENERAL.—Section 223(d)(2), as amended by 
the preceding provisions of this Act, is amended by adding 
at the end the following new subparagraph: 
‘‘(F) SUBSTANTIATION REQUIREMENT.— 
‘‘(i) IN GENERAL.—An amount paid 
or distributed from a health savings ac-
count shall not be treated as used to pay 
a qualified medical expense unless such 
amount is substantiated as a qualified 
medical expense. 
‘‘(ii) ASSESSMENT REQUIRED.—In the 
case of any expense with respect to which 
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a provider’s opinion is required to substan-
tiate such expense as a qualified medical 
expense under clause (i), such opinion shall 
not constitute substantiation unless— 
‘‘(I) such opinion is based on an 
assessment conducted pursuant to a 
bona fide provider-patient relation-
ship, 
‘‘(II) such assessment is con-
ducted in-person or is an assessment 
of a type that generally accepted 
standards of medical practice do not 
require to be in-person, and 
‘‘(III) the expense is incurred for 
an item or service of a type that 
would be typically recommended under 
generally accepted standards of med-
ical practice. 
‘‘(G) REGULATIONS.—The Secretary shall 
issue such regulations or other guidance as may 
be necessary or appropriate to carry out the 
purposes of this subparagraph.’’. 
(b) 
DETERMINATION
BY
TRUSTEE.—Section 
223(d)(1) is amended by adding at the end the following 
new subparagraph: 
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‘‘(F) In the case of any amount paid or 
distributed from the trust, the trustee shall de-
termine, consistent with the requirements of 
paragraph (2)(F), whether such amount has 
been substantiated as a qualified medical ex-
pense.’’. 
(c) EFFECTIVE DATE.—The amendments made by 
this section shall apply to amounts paid or distributed 
from a health savings account after December 31, 2025. 
SEC. 6. CERTAIN EXPENSES NOT TREATED AS MEDICAL 
CARE. 
(a) IN GENERAL.—Section 223(d)(2), as amended by 
the preceding provisions of this Act, is amended by adding 
at the end the following new subparagraph: 
‘‘(G) EXCLUSIONS.—For purposes of this 
paragraph, the amounts paid for the following 
shall not be treated as paid for medical care: 
‘‘(i) Spa and beauty treatments. 
‘‘(ii) So much of any amounts paid for 
exercise equipment as exceed $500 in any 
taxable year.’’. 
(b) EFFECTIVE DATE.—The amendment made by 
this section shall apply to amounts paid or distributed 
from a health savings account after December 31, 2025. 
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SEC. 7. EXCISE TAX ON EXCESSIVE HEALTH SAVINGS AC-
COUNT FEES. 
(a) IN GENERAL.—Subtitle D is amended by adding 
at the end the following new chapter: 
‘‘CHAPTER 50B—EXCESSIVE HEALTH 
SAVINGS ACCOUNT FEES 
‘‘Sec. 5000E. Excessive health savings account fees. 
‘‘SEC. 5000E. EXCESSIVE HEALTH SAVINGS ACCOUNT FEES. 
‘‘(a) IN GENERAL.—There is hereby imposed on the 
trustee of any health savings account which charges any 
excessive health savings account fee a tax equal to the ex-
cess of— 
‘‘(1) the amount of such fee, over 
‘‘(2) the reasonable amount of such fee as de-
termined under subsection (b)(3). 
‘‘(b) EXCESSIVE HEALTH SAVING ACCOUNT FEE.— 
For purposes of this section— 
‘‘(1) EXCESSIVE
HEALTH
SAVINGS
ACCOUNT 
FEE.—The term ‘excessive health savings account 
fee’ means any covered health savings account fee if 
such fee exceeds the reasonable amount of such fee 
as determined under paragraph (3). 
‘‘(2) COVERED
HEALTH
SAVINGS
ACCOUNT 
FEE.—The term ‘covered health savings account fee’ 
means any of the following if charged in connection 
with a health savings account: maintenance fees; 
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transfer fees; fees for paper statements, checks, or 
replacement cards; withdrawal fees; fees for insuffi-
cient funds; fees to ensure that fees do not exceed 
earnings or account balance; and such other fees or 
charges as the Secretary may identify for purposes 
of this paragraph. 
‘‘(3) REASONABLE FEES.—With respect to each 
category of fees described in paragraph (2) and such 
additional categories or subcategories as the Sec-
retary may provide, the Secretary shall determine 
the reasonable amount of such fee. 
‘‘(c) HEALTH SAVING ACCOUNT.—For purposes of 
this section, the term ‘health savings account’ has the 
meaning given such term in section 223.’’. 
(b) REPORTING.—Subpart A of part III of sub-
chapter A of chapter 61 is amended by inserting after sec-
tion 6039L the following new section: 
‘‘SEC. 6039M. INFORMATION REGARDING HEALTH SAVINGS 
ACCOUNT FEES. 
‘‘(a) IN GENERAL.—Each trustee of a health savings 
account which charges any covered health savings account 
fee during any calendar year shall, for such calendar year, 
make a return at such time and in such manner as the 
Secretary may provide setting forth the information de-
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scribed in subsection (b) and such other information as 
the Secretary may require. 
‘‘(b) INFORMATION.— 
‘‘(1) IN
GENERAL.—Each return under sub-
section (a) shall include, with respect to each cat-
egory of fee charged, a description of such fee, the 
number of such fees charged, and the aggregate 
amount of such fees charged. 
‘‘(2) SEPARATELY STATED CATEGORIES.—The 
information described in paragraph (1) shall be sep-
arately stated based on such demographic or other 
characteristics as the Secretary may provide. 
‘‘(c) DEFINITIONS.—Terms used in this section 
which are also used in section 5000E shall have the same 
meaning as when used in section 5000E.’’. 
(c) CLERICAL AMENDMENTS.— 
(1) The table of chapters for subtitle D is 
amended by adding at the end the following new 
item: 
‘‘CHAPTER 50B—EXCESSIVE HEALTH SAVINGS ACCOUNT FEES’’. 
(2) The table of sections for subpart A of part 
III of subchapter A of chapter 61 is amended by in-
serting after the item relating to section 6039L the 
following new item: 
‘‘Sec. 6039M. Information regarding health savings account fees.’’. 
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(d) EFFECTIVE DATE.—The amendments made by 
this section shall apply to fees charged after December 31, 
2025. 
SEC. 8. REPORTING OF EARNINGS ON CASH BALANCES OF 
HEALTH SAVINGS ACCOUNTS. 
(a) IN GENERAL.—Section 223(h) is amended by 
adding at the end the following: ‘‘The reports under para-
graph (1) shall include a statement specifying the average 
yield on cash balances in the health savings account of 
the account beneficiary for the period covered by the re-
port and a statement of the national average yield on sav-
ings account balances for such period (determined in such 
manner as the Secretary may provide).’’. 
(b) EFFECTIVE DATE.—The amendment made by 
this section shall apply to reports with respect to periods 
beginning after December 31, 2025. 
Æ 
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