How much have you thought about Health Savings Accounts (HSAs) and what happens to them once you enroll in Medicare? Whether you’re nearing age 65, wondering if you can keep contributing to your HSA, or curious about how you can use your HSA funds in retirement, this episode covers it all. I explain the rules around HSA contributions after enrolling in Medicare, the types of medical expenses you can pay for tax-free, and what happens to your HSA if there’s still money in it after you pass away.
You will want to hear this episode if you are interested in...
[01:51] Ineligibility to contribute to HSAs after enrolling in any part of Medicare
[03:02] When to stop HSA contributions
[05:46] Automatic Medicare enrollment when collecting Social Security or some retirement benefits
[08:00] Contrast between using IRA vs HSA to pay medical expenses
[09:39] Using HSA for family expenses
[14:27] Using the HSA post-65 for medical or other expenses
What Changes With Medicare?
One of the most important things to keep in mind is that once you enroll in any part of Medicare, you are no longer eligible to make HSA contributions. Continuing to contribute after enrolling in Medicare results in excess contributions, which are subject to a 6% excise tax each year the excess remains in the account. This penalty also applies to any income generated by those excess contributions, so immediate corrective action is necessary if you find yourself in this situation.
Importantly, Medicare Part A coverage can be retroactive for up to six months if you delay enrollment. Because of this, it’s recommended to stop contributing to your HSA at least six months before signing up for Medicare to avoid accidental over-contributions. Letting your employer know and possibly switching away from a high-deductible health plan before enrolling in Medicare can help prevent mistakes.
Can You Still Contribute If You’re Working Past 65?
Some individuals continue working beyond age 65 and may wonder if they can keep adding to their HSA. The answer depends on two main factors: your (or your spouse’s) participation in a qualified employer-sponsored health plan, and whether you are receiving Social Security or railroad retirement benefits.
If you’re still working and covered by a group plan with at least 20 employees, you can delay Medicare enrollment and keep contributing to your HSA. However, as soon as you start receiving Social Security or railroad benefits, you’re automatically enrolled in Medicare Part A, meaning you must halt HSA contributions—even if you’re still working. Carefully timing your Social Security enrollment can help maximize your HSA benefits.
Making Tax-Free Withdrawals: Qualified Expenses After 65
Once you turn 65, your HSA is yours for life, even though contributions must stop. Withdrawals for qualified medical expenses remain tax-free—these include doctor’s visits, prescription drugs, dental and vision care, hospital stays, Medicare Part B, Part D, and Medicare Advantage premiums, but not Medigap premiums. For example, if you and your spouse spend $500 monthly on Medicare premiums, you could take $6,000 out of your HSA tax-free each year.
Long-term care costs, including insurance premiums and care expenses, can also be paid with HSA funds within certain annual limits based on your age. These limits increase with age, reaching $6,200 per year for those 71 and older as of 2026.
What Happens to Your HSA After You Die?
Upon death, if your spouse is the named beneficiary of your HSA, the account simply becomes theirs—with all tax advantages preserved. For any other named beneficiary, the HSA must be cashed in and its balance treated as ordinary income, losing its tax-preferred status. If no beneficiary is named, the HSA passes to your estate, triggering potentially higher taxes and delays in distribution.