You can use your HSA to pay for your spouse’s Medicare premiums tax-free, but only after you, the HSA owner, turn 65. That rule covers Part A (if your spouse owes a premium), Part B, Part C (Medicare Advantage), and Part D. Medigap premiums are the one Medicare-related cost the statute leaves out.1Office of the Law Revision Counsel. 26 U.S. Code 223 – Health Savings Accounts
The Age-65 Rule Applies to You, Not Your Spouse
This is the detail that catches couples by surprise. The age threshold runs on the account holder’s age, not the Medicare enrollee’s. If you’re 60 and your spouse is 67 and on Medicare, you cannot pay their premiums from your HSA tax-free. The IRS states that when the account holder hasn’t reached 65, “Medicare premiums for coverage of your spouse or a dependent (who is 65 or older) aren’t generally qualified medical expenses.”2Internal Revenue Service. Publication 969 (2025), Health Savings Accounts and Other Tax-Favored Health Plans
Once you turn 65, that gate opens. You can then pay any qualifying Medicare premium for yourself or your spouse, no matter when your spouse enrolled. Your spouse doesn’t need their own HSA, doesn’t need to be on your health plan, and doesn’t need to be your tax dependent. They need to be your spouse when you pay the expense or when the medical service was provided.3Internal Revenue Service. Publication 502 (2025), Medical and Dental Expenses
Which of Your Spouse’s Medicare Premiums Qualify
Once you’ve crossed 65, the following premiums for your spouse are qualified HSA expenses:
- Part B (Medical Insurance). The standard premium for 2026 is $202.90 per month, with higher amounts for higher earners.4Centers for Medicare & Medicaid Services. 2026 Medicare Parts A and B Premiums and Deductibles
- Part C (Medicare Advantage). The premium for a private-plan alternative to Original Medicare qualifies.
- Part D (Prescription Drug Coverage). The national base premium for 2026 is $38.99 per month, plus whatever the specific plan charges.5Medicare.gov. 2026 Medicare Costs
- Part A (Hospital Insurance), if your spouse owes a premium. Most people pay nothing for Part A because they or a spouse earned 40 quarters of work credits. When a premium is owed, the full Part A premium in 2026 is $565 per month, and the reduced premium (30–39 quarters of coverage) is $311 per month.4Centers for Medicare & Medicaid Services. 2026 Medicare Parts A and B Premiums and Deductibles
Medigap is the exclusion to remember. The statute explicitly leaves Medicare Supplement policies off the list of insurance premiums payable with HSA funds.1Office of the Law Revision Counsel. 26 U.S. Code 223 – Health Savings Accounts If your spouse has a Medigap plan, those premiums come out of after-tax dollars.
What You Can Do If You’re Under 65
If you haven’t hit 65 yet, your HSA is the wrong tool for your spouse’s Medicare premiums specifically. It is not the wrong tool for your spouse’s other health costs. You can still use HSA funds at any age to pay for your spouse’s qualified medical expenses like prescriptions, doctor visits, and dental work. You can also use HSA funds to pay COBRA continuation coverage premiums for your spouse regardless of your age, because COBRA has its own separate exception within the HSA rules.2Internal Revenue Service. Publication 969 (2025), Health Savings Accounts and Other Tax-Favored Health Plans
If your spouse goes on Medicare before you turn 65, their premiums simply wait. Pay them from another source until you cross the age line, then shift to HSA-funded payments.
Reporting the Withdrawal
Every HSA distribution used for your spouse’s Medicare premiums is tax-free, but it still gets reported. Your HSA administrator sends you Form 1099-SA showing the year’s total distributions.6Internal Revenue Service. Form 1099-SA (Rev. April 2025) – Distributions From an HSA, Archer MSA, or Medicare Advantage MSA You then file Form 8889 with your Form 1040. Part II is where you report how much of the total went to qualified medical expenses for you, your spouse, and any dependents.7Internal Revenue Service. 2025 Instructions for Form 8889 Form 8889 is required in any year you take a distribution, even when every dollar was qualified.
Keep proof of the Medicare premium payments. Bank statements, Medicare billing notices, or screenshots from your Medicare account showing the amounts all work. The IRS doesn’t want the documents attached to your return, but if you’re audited you need to show distributions matched qualified expenses.
If You Withdraw for the Wrong Reason
If an HSA withdrawal doesn’t match a qualified expense, the consequences depend on your age. Before 65, the amount is added to your taxable income and hit with an additional 20% tax. After 65, the 20% additional tax goes away. The withdrawal is still ordinary income, but there’s no extra penalty, which puts it in roughly the same tax position as a traditional IRA distribution.2Internal Revenue Service. Publication 969 (2025), Health Savings Accounts and Other Tax-Favored Health Plans
If a distribution was taken by mistake, you can repay it to your HSA by the due date of your tax return for the year you discovered the error. A repaid mistaken distribution isn’t taxable income, isn’t subject to the 20% tax, and isn’t an excess contribution. Your HSA administrator isn’t required to accept the repayment, so check first.8Internal Revenue Service. Instructions for Forms 1099-SA and 5498-SA (12/2026)