You can use HSA funds tax-free to pay long-term care insurance premiums, but only if the policy meets the federal definition of a tax-qualified long-term care contract and only up to an annual dollar cap tied to your age. For 2026, the cap runs from $500 if you are 40 or younger to $6,200 if you are 71 or older.1Internal Revenue Service. Revenue Procedure 2025-32 Anything above the cap comes out of pocket, though it may still help on Schedule A.
2026 Age-Based Caps
The IRS adjusts these limits every year. Your age at the end of the tax year determines which tier applies. For 2026:1Internal Revenue Service. Revenue Procedure 2025-32
- Age 40 or younger: $500
- Age 41 to 50: $930
- Age 51 to 60: $1,860
- Age 61 to 70: $4,960
- Age 71 or older: $6,200
The cap is per person. If you and your spouse both carry qualifying policies, each of you gets your own age-based limit. A 58-year-old with a 62-year-old spouse can pull up to $1,860 for their own premium and up to $4,960 for the spouse’s premium in the same year, for $6,820 combined.2Internal Revenue Service. Publication 969 (2025), Health Savings Accounts and Other Tax-Favored Health Plans – Section: Insurance Premiums The same per-person cap applies to premiums you pay on behalf of a tax dependent.3Internal Revenue Service. Publication 502 (2025), Medical and Dental Expenses – Section: Long-Term Care
When your premium exceeds the cap, only the capped portion qualifies. A 55-year-old paying $4,000 a year can withdraw $1,860 tax-free from the HSA. The remaining $2,140 has to come from another source.
What Makes a Policy Qualify
Insurers usually label qualifying policies “tax-qualified,” but the underlying test lives in federal tax law.4Office of the Law Revision Counsel. 26 USC 7702B – Treatment of Qualified Long-Term Care Insurance Three things matter.
The policy must be guaranteed renewable, meaning the insurer cannot cancel your coverage as long as you keep paying. It cannot build cash value or be used as loan collateral. And its benefit trigger has to be strict: a licensed health care practitioner must certify either that you cannot perform at least two of six activities of daily living (eating, bathing, dressing, toileting, transferring, continence) for a period expected to last at least 90 days, or that you have a severe cognitive impairment requiring substantial supervision.4Office of the Law Revision Counsel. 26 USC 7702B – Treatment of Qualified Long-Term Care Insurance Policies that pay for lesser conditions do not qualify, and their premiums are not HSA-eligible.
Hybrid Life-LTC Policies
Hybrid policies that pair life insurance with a long-term care rider are the common trap. Life insurance premiums are never HSA-eligible. When the LTC rider is funded by drawing against the policy’s cash value rather than charged as a separate premium, that internal charge is not a medical expense either. The Pension Protection Act of 2006 drew that line explicitly.
Some newer hybrids do bill the LTC portion as a “separately identifiable” premium. If your policy is structured that way and otherwise meets the tax-qualified requirements, the LTC portion of the premium can come out of the HSA tax-free within your age-based cap. The life insurance portion never qualifies. Check your billing statement to see whether the insurer breaks out the LTC premium as its own line.
Paying and Reimbursing Yourself
The usual flow is to pay the insurer directly and then reimburse yourself from the HSA up to the age-based cap. Keep the premium statement, documentation that the policy is tax-qualified, and proof of the insured person’s age. You will not attach these to your return, but you need them if the IRS asks.
Report the distribution on Form 8889 with your federal return. The qualified LTC premium goes into Part II as a qualified medical expense. Filing Form 8889 is required in any year you take a distribution, even if every dollar went to qualified expenses.5Internal Revenue Service. Instructions for Form 8889 (2025) – Section: Purpose of Form
Pull more than the age-based cap and spend the excess on premiums, and the overage gets added to your gross income and hit with an additional 20% tax. The 20% piece goes away once you turn 65 or if you become disabled.6Internal Revenue Service. Instructions for Form 8889 (2025)
No Deadline for Reimbursement
There is no federal deadline for reimbursing yourself from an HSA. The only rule is that the expense had to be incurred after you established the account.7Internal Revenue Service. Publication 969 (2025), Health Savings Accounts and Other Tax-Favored Health Plans You can pay a 2026 premium out of pocket, leave the HSA invested for years, and reimburse yourself in 2032 or later. The distribution is tax-free as long as your records show when the expense occurred and that it was within that year’s age-based cap.
When Premiums Exceed the Cap
The same premium dollar cannot get two tax breaks. If you take $1,860 from the HSA tax-free, you cannot also claim that $1,860 as an itemized medical deduction on Schedule A.7Internal Revenue Service. Publication 969 (2025), Health Savings Accounts and Other Tax-Favored Health Plans
For most filers the HSA withdrawal is the better route because it gives you a full exclusion at every income level. Itemized medical deductions only help to the extent your total medical costs exceed 7.5% of your adjusted gross income.8Internal Revenue Service. Topic No. 502, Medical and Dental Expenses At $100,000 AGI you need more than $7,500 in medical spending before a single dollar deducts.
When your premium is above the cap, split it. Withdraw up to the cap from the HSA. Add the excess to whatever else you are pooling on Schedule A. In the earlier example, the 55-year-old paying $4,000 takes $1,860 from the HSA and drops the remaining $2,140 into the itemized medical bucket. Whether that $2,140 actually reduces taxes depends on clearing the 7.5% floor.
What Changes at 65
Once you enroll in Medicare, you can no longer contribute to an HSA. Most people enroll in Part A at 65, and Social Security enrollment triggers it automatically for many. Contributions stop, but withdrawals do not. You can keep pulling from the existing balance tax-free for qualified medical expenses, including LTC premiums within the age-based caps.2Internal Revenue Service. Publication 969 (2025), Health Savings Accounts and Other Tax-Favored Health Plans – Section: Insurance Premiums The 20% penalty on non-qualified withdrawals also drops at 65, so the worst case for a miscalculation becomes ordinary income tax rather than income tax plus penalty.
The practical window is the years between your mid-50s and 65: contribute aggressively, invest the balance, and build a pool that can absorb LTC premiums for the rest of your life. Combined with the no-deadline reimbursement rule, you can pay premiums out of pocket now while letting the HSA compound, then reimburse yourself years later.