HSA Rules Get Tricky Once You Hit Age 65

By Sarah Benner, IRA Analyst
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An HSA has been described as offering triple tax benefits. One, contributions are deductible. Two, there is no taxation on funds while they are in the HSA and, three, distributions taken for qualified medical expenses are tax-free. Not a bad deal! When you reach age 65, however, there are some important changes in store for your HSA.

HSA Benefits Continue
First, let’s talk about what stays the same. When you reach age 65, you can still access your HSA both tax and penalty free to pay for qualified medical expenses. Generally, qualified medical expenses are those that qualify for the medical expense deduction. This includes most medical, dental, vision and chiropractic expenses. You may take tax-and penalty-free distributions to pay for your spouse or dependents’ medical expenses as well as your own. You can even take a tax- and penalty-free distribution this year to reimburse yourself for medical expenses in a previous year, as long as the expenses were incurred after your HSA was established.

Expanded Benefits After Age 65
At 65, you will also gain some new benefits with your HSA. Certain insurance premiums can be paid tax free with HSA distributions after you reach age 65 and enroll in Medicare. You can pay for all Medicare premiums except Medigap. Employee payments of premiums for employer health insurance plans also qualify. You may also pay premiums for your spouse as long as you are age 65.

Distributions that you take from your HSA after age 65 are never subject to penalty. What you use the funds for does not matter. All HSA distributions after age 65 are penalty free, even if the funds are not used for qualified health expenses. However, if you take a distribution that is not used for qualified medical expenses, it will be taxable.

HSAs and Medicare
When it comes to making contributions to your HSA when you reach age 65, things can get a little tricky. This is due to the interaction of the HSA rules with Medicare. To be eligible to contribute to an HSA, you must have a High Deductible Health Plan (HDHP). You cannot have coverage under another plan that is not an HDHP. Because Medicare is not an HDHP, you cannot contribute to your HSA if you are enrolled in Medicare. Enrollment in any Medicare coverage (Parts A, B, C, D, or Medigap) will end HSA eligibility. Keep in mind that if you apply for Social Security benefits at age 65, you will automatically be enrolled in Medicare Part A.

You lose your eligibility to make an HSA contribution as of the first day of the month you turn age 65 and enroll in Medicare. You can make a pro-rated contribution for the year to your HSA for the months before you became ineligible due to your enrollment in Medicare. This contribution can be made until the HSA contribution deadline, which is generally April 15, of the following year.

Complicated Rules Call for Expert Advice
After you reach age 65, your HSA continues to offer big tax benefits, including some expanded possibilities for tax- and penalty-free distributions. However, you may also lose your ability to contribute. These rules are complicated and it’s easy to miss out on benefits or make costly mistakes. If you have questions about your HSA, be sure to consult with a knowledgeable tax or financial advisor.