Can I have a Health Savings Account (HSA) and Medicare?
Last updated Jul 19, 2026
Reviewed by Jason Burns, Editorial Steward
Published by Senior Direct Answers · Licensed under Citation License 1.0
Yes — you can keep and spend an existing HSA after joining Medicare — withdrawals stay tax-free for qualified medical expenses, including Part B, Part D, and Medicare Advantage premiums and cost-sharing — but you and your employer can no longer contribute once you are enrolled in any part of Medicare, and you must prorate your final-year contribution. Watch the retroactive Part A trap: if you enroll in Medicare (or claim Social Security) after 65, Part A is backdated up to 6 months, so stop HSA contributions up to 6 months before you apply or the backdated months' contributions become excess contributions subject to tax and penalty. Contribution limits change annually.
What the government has said, on the record
“For the all tax filers category, we excluded those 65 years and older because they are generally enrolled in Medicare and are ineligible to contribute to an HSA”
— John E. Dicken, Director of Health Care, U.S. Government Accountability Office (GAO), GAO testimony GAO-06-1133T before the Subcommittee on Health Care, Senate Committee on Finance, 2006-09-26 (source)
Editor's note: The sentence is a methodology footnote (p.7 n.12) of the testimony, though it directly states the contribution-ineligibility rule. Spending-side corroboration, verified verbatim: Treasury Secretary John W. Snow, Senate Special Committee on Aging, May 19, 2004: "They can also pay for out-of-pocket expenses under Medicare, including premiums for Part B and the new drug benefit (Part D)." (https://home.treasury.gov/news/press-releases/js1665)
Who said this
John E. Dicken — Director of Health Care, U.S. Government Accountability Office (GAO) (current).
Also asked as
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Last verified: 2026-07-18