HSA And Medicare | How They Interact & How It Affects You

An elderly woman talking to her doctor.

Many people choose to use a health savings account (HSA) to save some money on medical expenses. These accounts allow you to make tax-free contributions and use those funds to pay for qualified medical expenses. However, some strict eligibility rules must be met to qualify for an HSA. Unless you meet the rules, you are not allowed to make HSA contributions. So, what are those rules, and how does Medicare enrollment affect your eligibility for an HSA? Keep reading as we give you all the details. We will tell you exactly how to qualify for an HSA plus what you need to know when you’re approaching the age for Medicare coverage.

 

What Is A Health Savings Account?

So, what is an HSA, and how does an HSA work? A health savings account is a tax-advantaged savings account that allows you to use the money to pay for qualified medical expenses. You can put money into the account on a pre-tax basis, and you can then withdraw the money without paying taxes on it as long as the money is used to pay for specific medical expenses. The IRS recognizes this type of account, and it provides certain tax advantages for individuals who use these accounts. Using the withdrawals from your HSA to pay for expenses other than qualified medical expenses will lead to tax penalties and tax payments being due. The IRS also sets maximum contribution limits on these accounts. In 2022, you can contribute up to $3,650 to an individual account or $7,300 to a family account.

Most HSA accounts are set up similar to a checking account. Many include a debit card so that you can pay for your healthcare expenses directly from the account. For example, the funds could be used to pay for copays, coinsurance amounts, or deductibles for medical services. The HSA funds can also be used to pay for prescription drugs and some over-the-counter medications. The IRS requires that contributions to your HSA be reported on your income tax return, and you should also keep detailed records of the distributions or withdrawals. In the event of an audit, you might be required to produce documentation proving that the funds were used to pay for medical expenses that meet the IRS requirements.

 

HSA Eligibility

The health savings account rules prevent just anyone from contributing to an HSA. You must meet the eligibility requirements to qualify for one of these accounts. First, you must be enrolled in a high-deductible health plan (HDHP). This means that you are enrolled in a health insurance plan that includes a high deductible, so you will need to cover a lot of medical expenses out-of-pocket before your health insurance begins to pay for services. Next, you must not be enrolled in any other health care coverage. The high-deductible plan must be the only plan in which you are enrolled.

The IRS rules state that the deductible must be at least $1,400 per year for an individual or $2,800 per year for a family for the plan to qualify as an HDHP. These plans usually come with lower premiums, but you will incur higher out-of-pocket costs when you receive treatment. If you qualify, there are different ways to obtain an HSA. Some health savings plans are managed through your employer, while many banks and credit unions offer health savings plans. You might choose to enroll directly with your bank, but you will need to prove to them that you qualify for the account before you are allowed to make contributions.

 

How Medicare Enrollment Affects Your HSA

Medicare enrollment form.

Many people wonder how Medicare enrollment will affect their health savings accounts. Perhaps you are still employed and enrolled in a high-deductible plan for health coverage through your employer. Will enrolling in Medicare affect your HSA benefits? Medicare enrollment can affect your HSA contributions and HSA withdrawals differently. Here are the details.

 

— HSA Contributions

Enrolling in Medicare will immediately stop your eligibility to make HSA contributions. This applies to both Medicare Part A and Medicare Part B. If you are enrolled in Part A and/or Part B, you are no longer allowed to make HSA contributions. This is because the HSA rules state that you cannot be enrolled in any other health coverage besides an HDHP, and Medicare does not qualify as an HDHP. If you are still employed and enrolled in an HDHP, you might choose to delay your Medicare enrollment so that you can continue to make contributions to your health savings plan. You should also delay receiving your Social Security benefits since those benefits can qualify you for automatic Medicare enrollment. If you delay your benefits, you should stop your HSA contributions at least six months before enrollment in Medicare. We will discuss the reason why later in this article.

 

— HSA Payments & Reimbursements

What if you still have funds in an existing HSA when you enroll in Medicare? You can still use those funds tax-free to pay for qualified medical expenses. Enrolling in Medicare does not affect your ability to use the funds already in your account. You can continue to use those funds to pay for eligible expenses for the rest of your life or as long as you have a balance in your account. You can even use the funds to pay for Medicare premiums, like your Medicare Part B or Part D prescription drug coverage premiums, as well as Medicare Advantage plan premiums. However, you cannot use HSA funds to pay for Medicare supplement insurance or Medigap.

 

Delaying Medicare Enrollment To Keep Your HSA

Many people choose to delay their Medicare enrollment so they can continue to contribute to a health savings account. Since these accounts are tax-advantaged, continued contributions into these accounts can save some individuals lots of money on their taxes. However, you likely know that you become eligible for Medicare upon your 65th birthday. If you are already receiving retirement benefits from the Social Security Administration, you will be automatically enrolled in Medicare. You cannot delay your enrollment, even if you are still employed. However, if you are not receiving Social Security retirement benefits yet, you can delay your Medicare enrollment past age 65.

If you choose to delay your Medicare enrollment because you are already enrolled in an employer-sponsored HDHP, you will likely qualify for a Medicare special enrollment period upon your retirement. This means that you can still sign up for Medicare later without paying any late enrollment penalties. You can check out Medicare.gov to learn about the basics of Medicare, along with special enrollment periods and how COBRA coverage might also affect the timeframe in which you can enroll without a penalty.

You should also understand that your spouse might still be eligible to contribute to an HSA even if you are already enrolled in Medicare. For example, suppose that you and your spouse are both covered through your employer-sponsored high-deductible health plan. Even though your spouse is not the primary insured, they could still contribute to an HSA after you start receiving Medicare benefits. This might allow you to receive Medicare coverage while still getting some tax benefits from the health savings plan.

 

The Six Month Loopback Period Explained

If you delay your Medicare enrollment so you can continue to contribute to a health savings account, you need to be aware of the six-month loopback period. Remember that you typically can start Medicare coverage the month in which you turn 65. However, delaying your benefits can provide for a different start date. When you enroll in Medicare Part A late, you are entitled to retroactive benefits for up to six months prior to your enrollment. Remember that you cannot contribute to an HSA while you are enrolled in Medicare coverage.

So, when you delay your Medicare coverage, you must ensure that you stop your HSA contributions at least six months prior to signing up for Medicare. Otherwise, you could be making HSA contributions during a period in which you will have retroactive coverage under Medicare. This could lead to additional taxes due and even some tax penalties. If you are still employed during this period, you might qualify to utilize a flexible spending account (FSA) during this period. These accounts provide many of the same tax advantages as a health savings account, but the eligibility criteria are not as strict.

 

The Bottom Line

Health savings accounts can be a great way to take advantage of some tax savings for those enrolled in a high-deductible health plan. Your medical insurance company should be able to tell you whether your plan is considered an HDHP, but generally, it should have a deductible of at least $1,400 per year. If you are enrolled in Medicare, then you are not eligible to make new contributions to an HSA. However, you can continue to use the funds in your account to pay for qualified medical expenses, like monthly premiums, copays, and coinsurance amounts.

 

Frequently Asked Questions

 

Can you have an HSA and be on Medicare?

Yes, you can have an HSA and be on Medicare. However, you will not be allowed to make contributions to your HSA once you enroll in Medicare. Part of Medicare is the fact that it is meant to reduce your overall healthcare expenses. Therefore, it has a fairly low deductible. Since Medicare does not qualify as a high-deductible health plan, you cannot contribute to an HSA once you are enrolled. If you have an existing HSA prior to enrolling in Medicare, you can continue to use those funds to pay for qualified medical expenses.

 

Do you have to stop HSA contributions 6 months before Medicare?

If you are enrolling in Medicare during your initial enrollment period, you can contribute to an HSA up until the month of your 65th birthday. You can make HSA contributions until your Medicare coverage is effective. If you delay your Medicare benefits, you might be entitled to a six-month retroactive period of coverage. This means that your coverage could apply retroactively up to six months prior to your enrollment date. So, if you are delaying your Medicare enrollment, then you should stop HSA contributions at least six months before enrolling in Medicare. Otherwise, you might be making contributions during a period in which you will be covered by Medicare. This could have adverse tax consequences.

 

What happens to my HSA when I turn 65?

Nothing happens to your HSA at 65. If you are delaying your Medicare coverage, you can continue to make contributions and use your HSA account as normal. However, if your Medicare coverage starts at 65, you can no longer make HSA contributions. You can still keep the HSA account, though. You can even use the funds in the account to continue to pay for qualified medical expenses. Some people even choose to use the funds to pay their Medicare premium, deductible, or coinsurance amounts.

 

Can you contribute to an HSA and Medicare?

No, if you are enrolled in Medicare, you cannot contribute to an HSA. Your eligibility for making contributions to a health savings account stops once you are enrolled in Medicare. Even if you are still enrolled in an HDHP, you cannot be enrolled in any other health care coverage. Although you can no longer contribute to the account, you can still use the funds to pay for eligible medical expenses.

Elliot Marks

Elliot Marks

Elliot has spent years providing clear and concise information to help navigate the complex nuances of social security and many other government services in the United States. Elliot has a passion for helping those in need of these services to be able to find timely access to news and information that is relevant and helpful to their daily lives.