Can You Use Your HSA To Pay Health Insurance Premiums? A Clear Guide

Health Savings Accounts (HSAs) can be powerful tools for managing healthcare costs and saving on taxes. But the rules about what you can and cannot pay for with HSA funds can be confusing—especially when it comes to health insurance premiums.

This guide explains, in plain language, when you can use HSA money to pay premiums and when you can’t, plus how to avoid common mistakes that may lead to taxes or penalties.

HSA Basics: Why This Question Matters

An HSA (Health Savings Account) is a special savings account you can use to pay for qualified medical expenses on a tax-advantaged basis, if you’re enrolled in a High Deductible Health Plan (HDHP).

People often assume that because HSAs can be used for medical costs, they must also cover health insurance premiums. In reality, the rules are much more limited.

Key idea:
You generally cannot use HSA funds to pay regular health insurance premiums, but there are important exceptions.

The Short Answer: When You Can And Can’t Pay Premiums With HSA Funds

Here’s the big picture:

• ✅ Sometimes allowed:

  • COBRA premiums
  • Health insurance premiums while receiving unemployment benefits
  • Long-term care insurance premiums (within certain limits)
  • Medicare premiums after age 65 (with some restrictions)

• ❌ Generally not allowed:

  • Employer-sponsored health plan premiums (if you’re currently employed)
  • Individual health insurance premiums (such as marketplace/ACA plans), unless you’re on unemployment
  • Medigap (Medicare supplement) premiums
  • Most dental or vision insurance premiums

Let’s break this down clearly.

When You CAN Use HSA Funds To Pay Health Insurance Premiums

1. COBRA Coverage Premiums

If you leave a job and choose COBRA continuation coverage, you’re usually allowed to use HSA funds to pay the COBRA health insurance premiums.

Why this matters:
COBRA can be expensive because you’re often paying the full premium that your employer used to help cover. Using HSA dollars can ease the monthly cost.

Key point:
COBRA premiums are one of the clearest and most commonly used exceptions where HSA funds are allowed.

2. Health Insurance While You’re Unemployed

If you’re receiving unemployment compensation, you can generally use HSA money to pay for health insurance premiums during that period.

This can include:

• Individual health insurance you purchase while unemployed
• In some situations, other coverage you maintain while you’re actively receiving unemployment benefits

Watch out:
This exception typically applies only while you’re actually receiving unemployment compensation, not just when you are between jobs.

3. Certain Long-Term Care Insurance Premiums

You can usually use HSA funds to pay qualified long-term care insurance premiums, up to an annual limit based on your age.

• The allowable amount increases as you get older.
• Only premiums up to these limits are considered qualified medical expenses for HSA purposes.

This type of insurance helps cover services like assistance with daily living activities in long-term care settings, which can become very expensive.

4. Some Medicare Premiums After Age 65

Once you reach age 65, you can generally use HSA funds to pay certain Medicare premiums, including:

• Medicare Part B (medical insurance)
• Medicare Part D (prescription drug coverage)
• Medicare Advantage (Part C) plan premiums

However, Medigap (Medicare Supplement) premiums are not eligible to be paid from an HSA as qualified expenses.

Important:
Once you are enrolled in any part of Medicare, you can no longer contribute new money to an HSA. You can still spend the existing HSA funds, though.

When You CANNOT Use HSA Funds To Pay Premiums

1. Employer-Sponsored Health Plan Premiums (While Employed)

If you’re working and paying part of your health insurance cost through:

• Payroll deductions for your employer’s plan, or
• Your share of an employer-sponsored HDHP,

you generally cannot use HSA funds to reimburse those regular premiums.

Why?
These premiums are often already pre-tax through your paycheck. Using HSA funds on top of that would double up the tax advantage, which the rules don’t allow.

2. Individual or Marketplace (ACA) Health Insurance Premiums

If you buy your own health insurance, such as:

• A plan from the health insurance marketplace, or
• An off-exchange individual or family plan,

you generally cannot use HSA funds to pay those premiums—unless you qualify under one of the exceptions (for example, you are on unemployment).

This is one of the most confusing areas for consumers, but the rule is usually strict:

3. Medigap (Medicare Supplement) Premiums

Even though some Medicare costs are eligible, Medigap premiums are specifically excluded as qualified expenses for HSAs.

That means:

• You cannot use HSA funds tax-free to pay Medigap premiums.
• If you do, the amount would typically be treated as taxable income, and if you’re under 65, may be subject to an additional penalty.

4. Most Standalone Dental and Vision Insurance Premiums

HSA funds can generally be used for dental and vision care (for example, cleanings, fillings, glasses, and contacts), but not for the premiums of standalone dental or vision insurance policies, unless they qualify under one of the special exceptions.

Quick Reference: Can You Pay That Premium With HSA Funds?

Here’s a simple overview for common situations:

*Always verify your specific situation with a qualified tax or benefits professional.

What Counts As a Qualified Medical Expense (If Not Premiums)?

Even if you can’t use your HSA for your health insurance premium, you can typically use it for many other out-of-pocket healthcare costs, such as:

• Doctor’s visits and specialist visits
• Many prescription medications
• Deductibles, copays, and coinsurance
• Eligible dental and vision expenses
• Certain medical equipment and supplies

Using HSA funds for these items can still significantly reduce your overall healthcare costs, even if premiums themselves are off-limits most of the time.

What Happens If You Use HSA Funds for Non-Eligible Premiums?

If you use HSA money to pay for non-eligible health insurance premiums:

• The amount is generally treated as taxable income.
• If you are under age 65, it may also be subject to an additional penalty.
• If you are 65 or older, the penalty typically does not apply, but the amount is still taxable if it wasn’t an eligible expense.

Because of this, many people keep records and receipts to show which HSA withdrawals went to qualified expenses.

Practical Tips for Using Your HSA Wisely 📝

1. Know Your Exceptions

If you’re:

• Leaving a job and considering COBRA
• Unemployed and paying for your own health coverage
• Considering long-term care insurance
• Approaching or over age 65 with Medicare

…those are times when the HSA rules around premiums may work in your favor. It can be helpful to review the rules before making big decisions.

2. Coordinate With Your Other Tax Benefits

If your employer already takes health premiums out pre-tax, using HSA funds on top of that will usually not be allowed.

In general:

• Use payroll deductions or employer options for regular premiums.
• Use your HSA for eligible out-of-pocket medical expenses and, in some cases, the special premium categories listed earlier.

3. Keep Good Documentation

To stay organized:

• Save statements and bills for premiums you think may qualify (COBRA, Medicare, long-term care, etc.).
• Keep HSA withdrawal records aligned with those bills.

If questions ever come up, good records make it easier to show how you used your HSA.

4. Revisit Your Strategy as Your Life Changes

The way you use an HSA may change when:

• You change jobs
• You lose or gain coverage
• You become eligible for Medicare
• You consider long-term care planning

Checking the rules during those transitions can help you avoid missteps and make the most of your HSA.

The Bottom Line: Can You Pay Health Insurance Premiums With an HSA?

Most of the time, no.
You cannot use HSA funds for regular health insurance premiums for an employer plan or an individual/marketplace plan.

But in certain situations, yes:

• COBRA premiums
• Premiums while receiving unemployment benefits
• Qualified long-term care insurance premiums (up to age-based limits)
• Medicare Part B, Part D, and Medicare Advantage premiums after age 65
• Not Medigap premiums

Understanding these boundaries helps you use your Health Savings Account effectively, stay within the rules, and get the most benefit from your health insurance and HSA together.