HSAs are individually owned; therefore, spouses cannot have a joint HSA. However, each spouse who is an eligible individual and wants an HSA can open a separate HSA. While the accounts would be owned separately, either spouse’s HSA could be used to pay for the other spouse's expenses if they both meet the eligibility requirements. The combined annual contributions for both spouse’s HSAs cannot exceed the annual family maximum.
Alternatively, one spouse could open an HSA, which would cover the spouse and any other dependents. Then, the family would be subject to the annual maximum contribution limit set for families.1
1. “26 U.S. Code § 223 - Health Savings Accounts: 223(b)(5)(A) Special Rule for Married Individuals.” Legal Information Institute. Cornell Law School. https://www.law.cornell.edu/uscode/text/26/223.Updated: