If you are 65 or older, you can use your HSA to pay IRMAA tax-free. The IRS treats IRMAA as part of your Medicare Part B or Part D premium, and Medicare premiums become qualified medical expenses for HSA purposes once you reach 65.{1Internal Revenue Service. Publication 969 (2025), Health Savings Accounts and Other Tax-Favored Health Plans In practice you won’t hand your HSA debit card to Medicare: Social Security withholds the surcharge from your monthly benefit automatically, so using HSA funds means reimbursing yourself after the fact.
Why Age 65 Is the Dividing Line
Federal law generally blocks HSA distributions from being used for insurance premiums, then carves out a short list of exceptions.{2Office of the Law Revision Counsel. 26 U.S. Code 223 – Health Savings Accounts Medicare is one of them. Starting at 65, you can pay premiums for Part A, Part B, Part D, and Medicare Advantage from your HSA tax-free. Because IRMAA is not a separate tax or fee but an addition to the underlying Part B or Part D premium, it inherits the same treatment.
The 65 threshold looks at the account holder’s age, not a spouse’s or dependent’s. And if you are enrolled in Medicare before 65 because of disability or end-stage renal disease, the premiums still don’t qualify. The rule is age-based, full stop.
One exclusion catches people off guard: Medigap. Even after 65, HSA funds cannot be used tax-free for a Medicare supplemental policy. The statute specifically carves Medigap out of the Medicare premium exception, so if you carry both Medicare and Medigap, only the Medicare side qualifies.{2Office of the Law Revision Counsel. 26 U.S. Code 223 – Health Savings Accounts
How the Reimbursement Actually Works
Social Security deducts your Medicare premiums, IRMAA included, directly from your monthly benefit check. You rarely write a check to Medicare, so paying IRMAA “from” your HSA almost always means self-reimbursement. You take a distribution from the HSA equal to what Social Security already withheld, and the distribution comes out tax-free.
There is no deadline for that reimbursement. The IRS lets you pay a qualified medical expense out of pocket and reimburse yourself from your HSA later — days, months, or years — as long as the expense was incurred after the account was opened. Some account holders let the balance grow tax-free for years, then pull a lump reimbursement covering multiple years of premiums and surcharges at once.
What to Keep
Hold on to the Initial IRMAA Determination Notice Social Security sends you. It shows the exact surcharge amount and the income figures behind it.{3Medicare.gov. Initial IRMAA Determination Keep the Social Security statements or bank records showing the premium was actually withheld. The IRS wants documentation that the expense was real, that it wasn’t reimbursed from another source, and that you didn’t also claim it as an itemized deduction.{1Internal Revenue Service. Publication 969 (2025), Health Savings Accounts and Other Tax-Favored Health Plans Match your HSA distribution to the actual premium; don’t round up.
The Contribution Door Closes When Medicare Starts
You can spend HSA money on Medicare premiums after 65, but you cannot put new money in once you are enrolled in any part of Medicare. Federal law sets your contribution limit to zero beginning the first month you are entitled to Medicare benefits.{2Office of the Law Revision Counsel. 26 U.S. Code 223 – Health Savings Accounts
A common trap: if you claim Social Security before 65, you are automatically enrolled in Medicare Part A at 65, which immediately ends HSA contribution eligibility. Even if you delay Social Security, Part A enrollment can be applied retroactively up to six months, and that retroactive window can overlap months in which you contributed. Coordinate the timing carefully.
For 2026, the annual HSA contribution limit is $4,400 for self-only coverage and $8,750 for family coverage, with an additional $1,000 catch-up if you are 55 or older.{4Internal Revenue Service. Revenue Procedure 2025-19 Every dollar you get in before Medicare enrollment can later come out tax-free for premiums and IRMAA.
What Happens If You Are Under 65
If you are not yet 65 and you pull HSA money to cover IRMAA, the distribution is not qualified. The withdrawn amount gets added to your taxable income for the year and reported on Form 8889.{5Internal Revenue Service. Instructions for Form 8889 (2025) On top of the income tax, a 20% additional tax applies to non-qualified distributions. That 20% penalty disappears at 65, but the income tax on non-medical distributions does not.{1Internal Revenue Service. Publication 969 (2025), Health Savings Accounts and Other Tax-Favored Health Plans For IRMAA specifically, a distribution after 65 that matches your actual premium is fully tax-free.
A State Tax Caveat
Federal tax-free treatment of HSA distributions is honored by most states, but not all. California and New Jersey do not conform to the federal HSA rules. In those states, HSA contributions are taxable at the state level and investment growth inside the account is also subject to state income tax. A distribution that is entirely tax-free federally — including one used for IRMAA — can still generate a state tax bill if you live in either state. Factor that in before you rely on your HSA to absorb the surcharge.