By Sarah Brenner, JD
IRA Analyst

You may understand the basics of how an HSA works. The fundamental premise is not so complicated. If you have a qualifying high deductible health plan you may contribute to an HSA. Then, you can take tax-free distributions to pay for qualified medical expenses. Sometimes, those payments come in the form of a reimbursement. Other times you can pay for the medical expense right at the point of sale. You may not know, however, about some unexpected times when a tax-free distribution from your HSA may be possible. Here are 7 tax-free HSA distributions that may surprise you.

  1. Qualified medical expenses mean more than just doctor bills. Qualified medical expenses include those that would generally qualify for the medical expense deduction under the Tax Code. This means you can take a tax-free distribution from your HSA to pay not only medical expenses like doctor and hospital bills, but also medical supplies, prescriptions co-payments, dental care, vision services, even and chiropractic expenses.
  2. You can take tax-free distributions from your HSA to pay for your spouse or child’s medical expenses, even if they are not covered by your high deductible health insurance plan.
  3. You can take a tax and penalty-free distribution from your HSA in 2018 to pay for medical expenses in a previous year, as long as the expenses were incurred after you established your HSA. That means you do not have to make an HSA withdraw every time you have a medical expense. You can pay that expense from your pocket, and let your account grow, or decide to reimburse yourself in a later tax year.
  4. Even if you no longer have a high deductible health plan and you are no longer contributing to your HSA, you can keep the HSA and continue to take tax-free distributions from your HSA to pay for your qualified medical expenses for you, your spouse, and your dependents.
  5. You cannot contribute to an HSA once you are enrolled in Medicare. However, you can keep your existing HSA and you can still take tax-free distributions for qualified medical expenses.
  6. When you reach age 65, you also gain some new benefits with your HSA. Generally, insurance premiums are not considered qualified medical expenses. However, after age 65 and enrollment in Medicare, certain insurance premiums can be paid tax-free with HSA distributions. You can take tax-free distributions from your HSA to pay for Medicare premiums, excluding Medigap.
  7. If your HSA beneficiary is your spouse, after your death, he or she can maintain the HSA in his or her own name and can continue to access the funds. Distributions for qualified medical expenses will be tax free just as they would have been to you.