Can You Use HSA for Health Insurance Premiums After Retirement

A health savings account (HSA) can support your retirement plan through tax-deductible contributions, tax-free growth and tax-free withdrawals for qualified medical expenses. But not all insurance premiums qualify, so it’s important to know which costs you can and cannot cover with HSA funds. A financial advisor can help you review your expected healthcare needs, compare coverage options and decide how an HSA fits into your broader retirement strategy.

Rules for Using HSA Funds for Premiums After Retirement

Once you reach age 65, you gain more flexibility in how you can use your health savings account (HSA) funds, but there are still limits. The IRS allows tax-free withdrawals for certain Medicare-related premiums, while other premiums remain ineligible.

Qualified Premiums You Can Pay With an HSA

You can use HSA funds tax-free to pay these premiums.

Medicare Part A: For those ineligible for free coverage
Medicare Part B: Medical insurance
Medicare Part D: Prescription drug coverage
Medicare Advantage: Part C plans

If you have employer-sponsored retirement coverage after 65, you may also be able to use HSA funds to pay your share of those premiums, as long as the plan qualifies as group health coverage.

Withdrawals used for these expenses are considered qualified medical expenses under IRS rules. That means you can pay directly from your HSA or reimburse yourself later, but it is critical to keep good documentation for your records.

It’s important to note that after enrolling in any part of Medicare, you can no longer make new contributions to your HSA. However, you can continue to spend your existing balance on qualified medical expenses.

Premiums You Cannot Use HSA Funds For

Not all insurance premiums qualify for tax-free treatment. These HSA withdrawals are taxable income and may incur penalties if made before age 65.

Medigap (Medicare Supplement) policies
Private health insurance purchased outside of an employer or marketplace
Marketplace plans (ACA coverage) after Medicare eligibility begins

Even though Medigap helps cover deductibles and coinsurance, its premiums don’t qualify under current IRS rules.

Other Uses for HSA Funds in Retirement

HSA funds in retirement can also be used for qualified medical expenses beyond premiums, such as dental care, vision care and long-term care services.

While you can’t use an HSA to pay for most private insurance premiums, there are some exceptions and additional HSA benefits that make them especially valuable during retirement.

COBRA and Unemployment Exceptions

If you retire early or leave your job, you can use your HSA to pay health insurance premiums under COBRA continuation coverage or while collecting unemployment compensation.

These are the primary exceptions allowing early retirees to cover premiums with HSA funds before Medicare eligibility begins.

Long-Term Care Insurance

HSAs can help pay for tax-qualified long-term care insurance premiums, up to annual IRS limits that increase with age. For example, retirees in their 70s can use more HSA funds each year for this purpose than someone in their 50s.

This can be a valuable way to offset potential long-term care costs while preserving other assets.

Paying for Other Expenses After 65

Once you turn 65, you can withdraw HSA funds for non-qualified expenses without penalty, although you’ll owe ordinary income tax on those withdrawals. That means if your medical expenses are lower than expected, you could technically use your HSA for discretionary spending, such as travel or even a new boat, but you will lose the tax-free advantage.

Incorporating Your HSA Into Your Estate Plan

If you don’t end up using all your HSA funds during retirement, your account can become part of your legacy. However, how your HSA is treated after death depends on its beneficiary.

Spouse beneficiary. The account simply transfers to your spouse as their own HSA, preserving the same triple tax advantage. Your spouse can continue using the funds tax-free for qualified medical expenses.
Non-spouse beneficiary. The HSA stops being an HSA, and its fair market value becomes taxable income to the beneficiary in the year of your death.
Estate beneficiary. The fair market value of the HSA is included in your final income tax return.

For most people, naming a spouse as the beneficiary provides the greatest tax efficiency. However, if you don’t have a surviving spouse, you might consider naming an heir in a lower tax bracket or your estate, depending on your planning goals.

Strategic Considerations Before Using an HSA for Premiums

Before deciding how to use your HSA funds, consider how withdrawals fit into your overall financial and tax plan:

Preserve growth potential. Your HSA can double as a long-term investment vehicle. Because contributions, earnings and qualified withdrawals are all tax-advantaged, keeping your HSA invested for as long as possible may enhance your retirement healthcare flexibility.
Align tax planning. Strategic HSA withdrawals can affect your taxable income,Medicare IRMAA surcharges and Social Security benefit taxation. Ask a financial advisor for help coordinating your HSA withdrawals with other income streams to maximize tax efficiency.
Maintain detailed records. The IRS requires proof that each withdrawal corresponds to a qualified expense. Maintain records of premium statements, Social Security deductions and HSA transactions, as well as reimbursements made later.
Stagger withdrawals. Because HSAs have no required minimum distributions (RMDs), some advisors recommend tapping taxable or Roth accounts first. Allowing your HSA to grow longer enables tax-free compounding of your funds.
Consider state tax. While HSAs are federally tax-advantaged, some states tax HSA contributions or earnings. Review your state’s laws to confirm your local tax treatment.
Determine early retirement implications. For early retirees, it’s tempting to dip into HSA funds for current medical costs or premiums. However, maintaining your HSA for future healthcare expenses may provide greater long-term value.

Bottom Line

In retirement, an HSA can pay for select Medicare and long-term care premiums, while costs like Medigap generally must be paid out of pocket.

You can use an HSA to pay certain health insurance premiums after retirement, primarily for Medicare Parts A, B, D and Medicare Advantage plans. However, premiums for Medigap and most private policies don’t qualify. HSAs can also fund long-term care insurance, COBRA coverage and other healthcare expenses. Used wisely, your HSA can enhance your tax efficiency, extend your retirement savings and even play a role in your estate plan.

Tips for Retirement Planning

A financial advisor can help you estimate future healthcare costs in retirement and choose coverage and savings strategies that fit your budget and medical needs. Finding a financial advisor doesn’t have to be hard. SmartAsset’s free tool matches you with vetted financial advisors who serve your area, and you can have a free introductory call with your advisor matches to decide which one you feel is right for you. If you’re ready to find an advisor who can help you achieve your financial goals, get started now.
Mandatory distributions from a tax-deferred retirement account can complicate your post-retirement tax planning. Use SmartAsset’s RMD calculator to see how much your required minimum distributions will be.