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Can You Have an HSA and Medicare at the Same Time?

Are you permitted to maintain and contribute to an HSA when you're on Medicare. There are a few rules you need to know.

5 mins read
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A Health Savings Account (HSA) is a valuable tool for managing healthcare expenses. It operates as a personal savings account, enabling individuals to contribute pre-tax income to cover qualified medical expenses such as deductibles, copayments, and coinsurance. The tax-free withdrawal feature adds to its appeal, making HSAs an effective means of accumulating funds for potential health-related costs.

Understanding the intersection of HSA and Medicare is crucial as individuals approach Medicare eligibility. Medicare, a federal health insurance program primarily for individuals 65 and older, is pivotal in healthcare. The coexistence of an HSA and Medicare raises questions: Can they be utilized together? Navigating this intersection requires careful consideration and knowledge of the rules governing these healthcare options.

Can You Have Both an HSA and Medicare?

Let us understand how HSA and Medicare work and the impact of getting Medicare coverage on HSA. 

Compatibility of HSA with Medicare

Once you’re on Medicare, you cannot contribute to your HSA. Enrolling in either Medicare Part A or Part B prevents further pre-tax contributions to your HSA. Post-Medicare enrollment, your HSA contributions should be adjusted to zero. You can still withdraw funds for qualified medical expenses while maintaining the tax-free status. 

To reiterate, those approaching 65, working, and considering Medicare Part A should note that further pre-tax HSA contributions are barred once enrolled. For continued HSA growth while working, you can explore eligibility to delay Medicare enrollment unless you receive mandatory Social Security benefits.

Factors influencing eligibility for both HSA and Medicare

To qualify for HSA contributions, you must meet specific criteria:

  • You must be covered by a high-deductible health plan (HDHP) from the beginning of the month.
  • You should not have any other health coverage, except as permitted under the guidelines for other health coverage.
  • You should not be enrolled in Medicare.
  • You should not be eligible to be claimed as a dependent on someone else’s tax return. If someone else can claim you as a dependent on their tax return, you do not qualify for an HSA contribution deduction. 

As for eligibility for Medicare, it is generally for individuals aged 65 or older. Exceptions include early eligibility due to disability, End-Stage Renal Disease, or ALS. 

Implications of Having Both HSA and Medicare Coverage

If you contribute to your HSA after enrolling in Medicare, the IRS may view these contributions as ‘excess’, leading to an additional 6% tax when you withdraw them. Enrolling in Medicare during your HSA testing period could result in back taxes and an extra 10% tax on these contributions. 

Whether or not to delay Medicare enrollment depends on your situation. If you work for a small employer (less than 20 employees), you may need Medicare for primary insurance, even though you lose HSA tax benefits. Small employer health plans pay after Medicare. 

For larger employers, Medicare pays second, so you can delay enrollment and keep funding your HSA. Remember, you get a Part B Special Enrollment Period if you lose coverage or retire. If you decide on delaying Medicare for HSA contributions, wait to collect Social Security and stop HSA contributions six months before enrolling in Medicare to avoid tax penalties.

HSA Contributions and Medicare Enrollment

Let us look at how HSA contributions and Medicare work in conjunction with each other:

How HSA Contributions Work Alongside Medicare

HSA contributions work alongside Medicare by allowing tax-free withdrawals for qualified medical expenses, provided you meet the eligibility criteria specified above. 

Impact of Medicare Enrollment on HSA Contributions

As explained above, enrolling in Medicare prevents further contributions to your HSA. If you continue to contribute, it can result in IRS penalties.

Strategies for Optimizing HSA Contributions and Medicare Benefits

If you set up an HSA before joining Medicare, you can still use the money in it even after enrolling in Medicare. Workers can stay in HSA-eligible plans and utilize existing HSA funds for eligible expenses, but new contributions aren’t allowed once enrolled in Medicare. Contrary to a common belief,  if you decide to enroll in Medicare, there’s no need to stop making HSA contributions at age 64 ½; you can continue until your 65th birthday month without any tax issues. 

For those working past age 65, you can postpone Medicare enrollment if you work for a large employer with more than 20 employees. You can also keep your HDHP and fully fund your HSA. When you’re ready to retire, apply for Medicare around the same time you leave your work health plan. It’s best to stop putting money into your HSA six months before applying because Medicare can have a retroactive start date

If you receive Social Security at 65, Medicare enrollment occurs automatically. It ends HSA contributions unless you opt out within 12 months and repay the benefits.

Using HSA Funds for Medicare Expenses

Let’s explore how to use your HSA money when you have Medicare.

Approved medical expenses covered by HSA funds

You can use your HSA funds to pay for the regular monthly expenses of Medicare Part B, Part C, and/or Part D. This covers the standard premium and any additional charges for a plan with reduced costs. Your HSA can also assist with Medicare deductibles and copayments. Remember that you can’t use it for long-term care insurance, or Medigap premiums.

Guidelines for using HSA funds to pay for Medicare-related costs

Follow these guidelines when using HSA funds for Medicare-related costs: Keep receipts for expenses, submit claims as required, review state and federal laws, and verify HSA payment eligibility for Medicare costs on the IRS website

Your HSA funds can be tax-free for qualified expenses for yourself, your spouse, children, stepchildren, adopted children, and tax dependents, regardless of their coverage under your high-deductible health plan or HSA enrollment.

Tips for Maximizing HSA Funds while on Medicare

Although you can’t add to your HSA during Medicare, having one benefits you from tax advantages. Setting up your HSA before Medicare eligibility, making the maximum yearly contribution, and investing for the long term are vital strategies for maximizing the benefits of your HSA.

Potential Pitfalls and Challenges

Leveraging HSA once you qualify for Medicare can be tricky as there are a few inherent challenges.

Common Issues Individuals May Face with HSA and Medicare

Common issues individuals may face with HSA and Medicare involve uncertainty about when to halt HSA contributions upon Medicare enrollment. Individuals may also struggle with proper documentation for eligible expenses, understanding limitations on using HSA funds for certain Medicare-related costs, and knowing when to delay Medicare enrollment for maximum financial benefit. 

How to Navigate Challenges and Find Solutions

To avoid potential pitfalls, it is advised to thoroughly review guidelines and seek expert advice when needed for practical solutions.

Insights on Mitigating Risks

Mitigate risks associated with HSA and Medicare by staying informed on regulations, consulting financial professionals, and exploring comprehensive coverage options. 

Reach out to CoverRight for expert advice and coverage solutions. We’re here to assist you in understanding the intricacies of Medicare and optimizing your coverage.

Frequently Asked Questions

Can I contribute to an HSA while on Medicare?

No, you can no longer save on HSA once you are on Medicare. You can, however, maintain an existing HSA from before enrollment and use it for qualified medical expenses.

What eligible medical expenses can I cover with HSA funds on Medicare?

HSA funds can be used for qualified medical expenses, including premiums, deductibles, and copayments under Medicare.

Are there penalties for using HSA funds improperly with Medicare?

Taking a non-qualified HSA distribution incurs ordinary income tax and a 20% penalty unless you’re 65 or older, disabled, or in the year of your death. Confirming distributions for qualified medical expenses is an IRS requirement.

Can I open an HSA if I am already enrolled in Medicare?

No, you cannot open a new HSA once enrolled in Medicare, but you can still use existing HSA funds for eligible medical expenses.

Richard Chan

Richard is the Founder of CoverRight and based in New York. He is passionate about empowering consumers to take control of their health and finances. Prior to starting CoverRight, Richard had extensive experience working in financial services with over 8 years' experience in consumer lending and investment banking.

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