The benefits of a health savings account (HSA) are many. Deposit your pre-tax dollars up to the predetermined IRS limit ($3,350 per individual and $6,650 for family coverage in 2015), and withdraw the money as needed for qualified medical expenses. Any funds not needed now can be accessed in the future, as the money rolls over from year to year and continues to grow.
Pre-tax HSA dollars reduce the sting of co-payments and deductibles and provide a way for individuals to prepare for upcoming health-care costs. What's more, individuals with medical and dental expenses below the IRS threshold (check IRS Publication 502) can use an HSA to receive tax savings on income that would otherwise be fully taxable.
With all that Medicare doesn't cover (get the details in Medigap Insurance: Who Needs It?), who could blame a Medicare recipient for thinking an HSA sounds like an idea worth investigating, especially given that after age 65, HSA monies can be withdrawn for any reason without penalty – and can be spent tax free if used for qualified medical expenses. (If you spend the money on something else, it will be taxed as ordinary income, however.) See How to Use Your HSA for Retirement and Rules for Having a Health Savings Account (HSA) for more.
There's just one problem.
Who's Eligible to Open an HSA?Health savings accounts are open to anyone with a high-deductible health plan (HDHP), who:
Wait...does that mean anyone on Medicare should stop reading this article? Not necessarily.
HSA ‘Loopholes'Although Medicare recipients are prohibited from opening an HSA account, there are a couple of ways to get around the law in a perfectly lawful manner.
1. Eligible isn't the same as enrolled. IRS rules don't prohibit someone who's eligible for Medicare (but hasn't yet elected to participate) from opening an HSA account. If it makes sense for you to postpone enrolling in Medicare (because you're covered under an employer's plan, for example), you could defer your participation and still be eligible to open an HSA. If your HSA is employer-sponsored and your employer funds the account, that's even better.
Still, no one should make this decision without exploring the potential consequences. In most cases you'll pay a penalty if you don't sign up for Medicare when you're first eligible (see the late enrollment penalty), unless you enroll during a Special Enrollment Period.
(Note: Since you can't contribute to an HSA during any month you're enrolled in Medicare, be sure that whenever you do decide to enroll – assuming you're at least six months past retirement age at the time – you account for the six-month retroactive period, or you may find yourself on the hook for six months of tax penalties.)
2. You may be able to access a new HSA through a spouse's account. Your spouse is eligible to open an HSA if he or she has his or her own HDHP, is not covered under your plan and is not on Medicare.
3. If you already have an HSA, you can continue to benefit from it. While the law prohibits you from opening and/or contributing to an HSA after you become enrolled in Medicare, you are not prohibited from spending down HSA monies from an account you opened before your Medicare plan started.
The Bottom LineMedicare recipients are prohibited from opening an HSA – a prohibition that also extends to those under the age of 65 on Medicare because of a disability. But individuals who are eligible for Medicare and not yet enrolled can possibly qualify. If this describes your situation, be sure to investigate the consequences of postponing Medicare enrollment and stop making HSA contributions six months prior to your application date to avoid tax liability when Medicare retroactively grants benefits.
Note that nothing under the law prevents a Medicare recipient from receiving benefits under a spouse's health savings account.