Is Health Insurance Premiums HSA-Eligible? (2026)
Most health insurance premiums are not HSA-eligible, but federal rules provide specific exceptions.
Typical Cost
Only premiums within a listed federal exception
Details
Publication 969 says HSA funds generally cannot pay insurance premiums. The listed exceptions are qualified long-term care insurance within age-based limits, continuation coverage such as COBRA, health coverage while receiving federal or state unemployment compensation, and Medicare or other health coverage after the HSA beneficiary reaches age 65, excluding Medigap.
What to do next
Identify the exact exception before using HSA funds. Keep premium statements and proof of COBRA, unemployment status, age, or long-term-care eligibility as applicable. Medigap is not included.
Decision record and source basis
This ruling has a source packet that directly addresses the item or rule below. A product or retailer label does not override the expense purpose, eligibility conditions, or documentation requirement shown above.
Search coverage (7 product and plain-English terms)
cobra premiums, health coverage premiums, health plan premiums, medicare premiums, medigap premiums, medical insurance premiums, unemployment health insurance.
- IRS Publication 969: Insurance Premiums
Publication 969 states the general prohibition and the limited HSA exceptions for long-term care, COBRA, unemployment coverage, and coverage after age 65 other than Medigap.
Source reviewed
Frequently Asked Questions
Can I pay ordinary health insurance premiums with my HSA?
Generally no. Publication 969 lists limited exceptions for long-term care, COBRA, unemployment coverage, and certain coverage after age 65.
Are Medigap premiums HSA-eligible after age 65?
No. Publication 969 excludes Medicare supplemental policies such as Medigap from the age-65 exception.
Can you reimburse health insurance premiums years later?
Compare timing assumptions, investment risk, and the records needed to support a later distribution.
Related HSA Expenses
Long-Term Care Insurance Premiums
$1,000–$5,000+ per year (varies by age and coverage)
Coinsurance & Deductibles
Varies by plan - $1,600–$8,050+ (HDHP deductible range for 2024)
Doctor Visits
$20–$300 per visit (varies by type and insurance)
Direct Primary Care Membership
Fixed periodic fee; contribution-eligibility thresholds are year-specific
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