Can I Use My HSA to Pay for My Spouse’s Medicare Premiums?

You can use your HSA to pay your spouse’s Medicare premiums tax-free once you, the HSA owner, turn 65. That covers premiums for Part A (if your spouse owes one), Part B, Part C (Medicare Advantage), and Part D. Medigap premiums are the exception written into the statute and never qualify.¹

Which of Your Spouse’s Medicare Premiums Qualify

Federal law allows HSA funds to pay health insurance premiums after the account holder turns 65, and that carve-out covers all Medicare premiums except Medicare Supplement (Medigap) policies.¹ For your spouse, the qualified premiums are:

Part B (Medical Insurance). The standard 2026 premium is $202.90 per month, with higher amounts for high earners.²
Part C (Medicare Advantage). Whatever the private plan charges.
Part D (Prescription Drug Coverage). The 2026 national base premium is $38.99 per month, plus your spouse’s specific plan cost.³
Part A (Hospital Insurance). Most people pay nothing because they or a spouse earned at least 40 quarters of work credits. If a premium is owed, the full 2026 amount is $565 per month, and the reduced premium for 30–39 quarters is $311 per month.²

Medigap is the boundary to keep in mind. If your spouse carries a Medicare Supplement plan alongside Original Medicare, those supplement premiums are not a qualified HSA expense and have to come from after-tax money.¹

The Age Rule Follows You, Not Your Spouse

The age-65 threshold applies to the HSA owner. If you’re 60 and your spouse is 67 and already on Medicare, you cannot use your HSA to pay their Medicare premiums 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.”⁴

Once you hit 65, the gate opens for both of you. 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 just have to be your spouse at the time you pay the expense or at the time the underlying service was provided.⁵

If you’re still under 65, your HSA is the wrong tool for your spouse’s Medicare premiums specifically, but it still covers their other qualified medical costs at any age: prescriptions, doctor visits, dental work. HSA funds can also pay COBRA continuation premiums for a spouse regardless of your age, since COBRA has its own separate exception in the statute.⁴

What the Tax Break Is Actually Worth

Paying premiums from your HSA instead of after-tax dollars saves you your marginal tax rate on every dollar. A spouse paying the standard $202.90 monthly Part B premium plus a Part D plan runs roughly $3,000 a year in premiums. At a 22% federal bracket, routing that through an HSA saves about $660 a year compared to paying with after-tax money.

High earners save more because their premiums are higher. Medicare uses the tax return from two years earlier to set income-related monthly adjustment amounts. For 2026, a married couple filing jointly with modified AGI above $218,000 pays a higher Part B premium ranging from $284.10 up to $689.90 per month, depending on income.² Part D surcharges add another $14.50 to $91.00 per month on top of the plan premium.³ Every one of those dollars can leave the HSA tax-free.

Watch Out for Retroactive Part A Enrollment

One trap catches couples who kept contributing to an HSA after 65. When you apply for Medicare Part A after turning 65, coverage is backdated up to six months.⁶ Your HSA contribution limit is zero for every month you’re covered by Medicare, so a six-month backdate turns six months of contributions into excess contributions. Filing for Social Security after 65 triggers Part A enrollment automatically, which is how this problem sneaks up on people who delayed Social Security but stayed on an HDHP.⁴

You can avoid the 6% excise tax by withdrawing the excess before your tax return filing deadline, including extensions. The withdrawn amount is taxable income, but the 20% additional tax that usually applies to non-qualified distributions doesn’t hit once you’re 65. If the excess stays in the account past the deadline, the 6% excise applies for each year it remains.⁴

How to Report the Distribution

A tax-free distribution still gets reported. Your HSA administrator sends you Form 1099-SA showing total distributions for the year.⁷ You file Form 8889 with your Form 1040, and Part II is where you break out how much went to qualified medical expenses for you, your spouse, and any dependents.⁸ Form 8889 is required in any year you take a distribution, even if the whole thing was qualified and nothing is taxable.

Keep proof of the premium payments: Medicare billing notices, bank statements, or screenshots from your spouse’s Medicare account showing the amounts paid. You don’t submit documentation with your return, but if the IRS asks, you’ll need to show each distribution lined up with a qualified expense.

1
Office of the Law Revision Counsel. 26 U.S. Code 223 – Health Savings Accounts
2
Centers for Medicare & Medicaid Services. 2026 Medicare Parts A and B Premiums and Deductibles
3
Medicare.gov. 2026 Medicare Costs
4
Internal Revenue Service. Publication 969 (2025), Health Savings Accounts and Other Tax-Favored Health Plans
5
Internal Revenue Service. Publication 502 (2025), Medical and Dental Expenses
6
Centers for Medicare & Medicaid Services. Original Medicare (Part A and B) Eligibility and Enrollment
7
Internal Revenue Service. Form 1099-SA (Rev. April 2025) – Distributions From an HSA, Archer MSA, or Medicare Advantage MSA
8
Internal Revenue Service. 2025 Instructions for Form 8889