Yes, you can use your HSA to pay Medicare premiums tax-free once you turn 65. Premiums for Part A, Part B, Part C (Medicare Advantage), and Part D all qualify, along with any IRMAA surcharges attached to them. Medigap premiums are the one significant exclusion. You lose the ability to make new HSA contributions the moment you enroll in Medicare, but the balance already in your account stays yours for life and can pay these premiums indefinitely.
Which Medicare Premiums Qualify
IRS Publication 969 identifies the Medicare premiums that count as qualified medical expenses for HSA holders age 65 and older:
- Part B medical insurance premiums, including the standard premium ($202.90 per month in 2026) and any Income-Related Monthly Adjustment Amount surcharge.1Centers for Medicare & Medicaid Services. 2026 Medicare Parts A & B Premiums and Deductibles
- Part D prescription drug premiums, plus any Part D IRMAA surcharge.
- Part C (Medicare Advantage) premiums if you take that route instead of Original Medicare.
- Part A hospital insurance premiums, if you owe one. Most people do not, because they or a spouse earned enough work credits.2Internal Revenue Service. Publication 969, Health Savings Accounts and Other Tax-Favored Health Plans – Section: Insurance Premiums
HSA money also covers Medicare deductibles, copayments, and coinsurance as qualified medical expenses. Those out-of-pocket costs are tax-free at any age, not just after 65.
Medigap Premiums Do Not Qualify
Publication 969 specifically excludes “premiums for a Medicare supplemental policy, such as Medigap” from the list of eligible insurance expenses.2Internal Revenue Service. Publication 969, Health Savings Accounts and Other Tax-Favored Health Plans – Section: Insurance Premiums If you pull HSA money to pay a Medigap premium, the distribution is taxable income. The 20% additional tax no longer applies after 65, but you will owe ordinary income tax on the amount.
If you make this mistake by accident, the IRS lets you return a mistaken distribution to your HSA no later than the due date of that year’s tax return, provided your custodian accepts the repayment. Done correctly, the distribution is not included in income.3Internal Revenue Service. Instructions for Forms 1099-SA and 5498-SA
How to Actually Pay the Premiums
There are two practical ways to move HSA money toward Medicare, and which one you use depends on how the premium is being collected.
Direct Payment
Medicare accepts HSA debit cards for Part A and Part B premiums. You can pay through your online Medicare account, which routes the transaction through Pay.gov, or mail a payment using your HSA card number on the coupon that comes with your Medicare bill.4Medicare. How to Pay Part A & Part B Premiums For Part D and Medicare Advantage, ask the plan directly whether it accepts HSA card payments.
Reimbursing Yourself for Premiums Taken From Social Security
If you receive Social Security, your Part B and often your Part D premiums are deducted from your benefit before it hits your bank account. You cannot pay those premiums with your HSA card because Medicare has already collected them. What you can do is reimburse yourself: transfer an equal amount from the HSA to your checking account as a qualified distribution.
There is no time limit on this reimbursement. The IRS allows you to pay yourself back for any qualified expense incurred after the HSA was opened, even years later, as long as you keep the records.5Internal Revenue Service. Publication 969, Health Savings Accounts and Other Tax-Favored Health Plans – Section: Distributions From an HSA Hold on to your Social Security benefit statements or Medicare billing notices as proof of the premiums you paid, and make sure you have not also claimed the same expense as an itemized deduction or been reimbursed from another source.
Paying a Spouse’s Medicare Premiums
Your HSA can cover a spouse’s or tax dependent’s Medicare premiums, but there is a wrinkle worth understanding. The age-65 rule that unlocks tax-free premium payments applies to you, the HSA account holder, not to the person whose premium is being paid.2Internal Revenue Service. Publication 969, Health Savings Accounts and Other Tax-Favored Health Plans – Section: Insurance Premiums
So if you are 65 and your spouse is on Medicare, you can pay their premiums from your HSA tax-free. Your spouse does not need to have shared your high-deductible plan or to own their own HSA. But if you are under 65 and your spouse is already on Medicare, you cannot use your HSA for their premiums on a tax-free basis. The account holder’s age is what matters.
For an unmarried partner, HSA distributions are tax-free only if that person qualifies as your tax dependent under federal rules.
You Cannot Contribute After Medicare Starts
The first month you are enrolled in any part of Medicare, your HSA contribution limit becomes zero.6Internal Revenue Service. Publication 969, Health Savings Accounts and Other Tax-Favored Health Plans – Section: Enrolled in Medicare The existing balance is safe. You can spend it on qualified expenses, including the Medicare premiums above, for the rest of your life. But nothing new goes in.
If Medicare starts partway through a year, your contribution limit for that year is prorated by the number of months you were HSA-eligible before coverage began, measured by your status on the first of each month.
The Retroactive Part A Trap
This is the mistake that catches people who work past 65. When you apply for Social Security retirement benefits after 65, you are automatically enrolled in Medicare Part A, and that enrollment is backdated up to six months (no earlier than the month you turned 65). Any HSA contributions you or your employer made during those retroactive months become excess contributions.
Excess contributions carry a 6% excise tax for every year they sit in the account.7Internal Revenue Service. Instructions for Form 8889 – Section: Tax on Excess Contributions To avoid the penalty, withdraw the excess and any earnings on it before the due date of that year’s tax return, including extensions. An amended return may be necessary if you have already filed.
The clean way to avoid the trap: stop HSA contributions at least six months before you file for Social Security or Medicare. If you want to keep contributing while working past 65 under employer HDHP coverage, hold off on both applications until you are ready to give up contributions, then stop contributing six months before you apply.
Reporting the Distributions
Every HSA distribution has to be reported on Form 8889, even the ones that go entirely to qualified medical expenses. Medicare premium reimbursements are qualified distributions and go on Line 15. Because they were used for qualified expenses, they are excluded from gross income.8Internal Revenue Service. Instructions for Form 8889
Anything you pull out for non-qualified purposes is taxable income. After 65 you are done with the 20% penalty, but ordinary income tax still applies to non-qualified withdrawals, which then behave a lot like traditional IRA distributions.9Office of the Law Revision Counsel. 26 U.S.C. 223 – Health Savings Accounts Medicare premiums, paid or reimbursed from an HSA after 65, stay on the tax-free side of that line.