Medicare Part A Retroactive Coverage and HSA’s

Medicare Part A is a government administered health insurance plan generally for people aged 65 and older. It is a form of hospital insurance that covers inpatient hospital care, skilled nursing facilities, and other types of health care services. The general assumption is that Health Savings Account holders can maintain their HSA until they begin Medicare, and then easily hop onto Medicare Part A. As you will see, this may not be so, as there are some catches with Medicare Part A that affect your HSA eligibility based on your age and enrollment date.

People over the age of 65 do not have to sign up for Medicare; they can remain on a personal insurance plan (such as an HSA) as long as they want. However, once you elect to being coverage, or begin receiving Social Security, you are enrolled in Medicare Part A. While this not only ends your HSA eligibility (see next section), it may affect your HSA eligibility in previous months. For those who begin Part A coverage after they have turned 65, there is a clause that retroactively applies Medicare coverage. It states that your coverage start date actually begins up to 6 months prior to your actual enrollment date. From the Medicare.gov website:

If you sign up within 6 months of your (upcoming) 65th birthday, your coverage will start at one of these times:
1) The first day of the month you turn 65
2) The month before you turn 65 (if your birthday is on the 1st of the month
After that, you’re coverage will go back (retroactively) 6 months from when you sign up.

It is that last clause that can really affect HSA holders. It states that if you sign up for Medicare Part A after you turn 65, the coverage will retroactively be applied up to 6 months into the past. While this added “benefit” may be great and help cover some prior costs, it begs the question: what if I had an HSA during those 6 months of retroactive Medicare coverage?

Medicare Part A Affects HSA Eligibility

The short answer to the above question is “nothing good”. First things first, we need to make clear the requirements for being able to contribute to a Health Savings Account. Note that these requirements are for new contributions only; once you successfully contribute to an HSA, the funds they are yours forever. However the key word in that sentence is “successfully”, as you must be HSA eligible for the contribution to be valid. Per IRS Publication 969, HSA eligibility requires:

  1. You are covered by a high deductible health plan
  2. You have no other health coverage (few exceptions)
  3. You aren’t enrolled in Medicare
  4. You can’t be claimed as a dependent

Obviously, points 2 and 3 stick out like a sore thumb. In essence, you can be following the rules as an HSA eligible individual, and 6 months after the fact be retroactively disqualified (made HSA ineligible) due to Medicare Part A. If you are familiar at all with how HSA tax Form 8889 works, you know that this can pose some serious risks to your financial well being.

When does Medicare coverage start?

The Medicare website mentions the 6 months of retroactive coverage but is very vague as to how it applies. The answer is Medicare coverage can be retroactive up to 6 months, if you sign up after your 65th birthday. The rule is if you sign up after turning 65, the Medicare coverage will be retroactive to the lessor of 1) the first day of your birthday month or 2) 6 months. Of course the government makes such a cockamamie rule, but oh well. Here are some examples for someone whose birthday is March 30th:

  • Medicare starts June 1st – retroactive coverage until March 1st (birthday month)
  • Medicare starts September 1st – retroactive coverage until March 1st (birthday month)
  • Medicare starts December 1st – retroactive coverage until June 1st (6 months)

An HSA + Medicare Part A Nightmare Example

Here’s an example of how bad this can go. Paul turns 65 in January of 2016 and becomes eligible for Medicare and Social Security but chooses to keep his day job as a bass player and to maintain his HSA eligible family insurance. Being in a lucrative field, Paul contributes the maximum to his family coverage Health Savings Account each year. In April of 2016, Paul chose to make a qualified funding distribution from his IRA to contribute the maximum to his HSA.

On May 1st, 2017, Paul plays the last show of his final farewell tour and decides to officially retire. He takes some of the proceeds from the show and contributes 4 months worth of a contribution to his HSA for 2017. No longer working, Social Security seems like a good deal so he signs up to start receiving benefits. This also enrolls him in Medicare Part A, which seems like free government sponsored medical care. Paul relaxes in his Palm Springs desert home and enjoys his retirement.

The next year, Paul gets a call from his tax accountant telling him his HSA Form 8889 is a mess and he may owe penalties and taxes. Because Paul was 67 when he signed up for Medicare Part A on May 1st, 2017, the coverage retroactively applied 6 months prior to November 1st, 2016. This means that he was not HSA eligible from November 2016 – April 2017. His accountant informs him that as a result, Paul has over contributed to his HSA for the 4 months in 2017 which will have to be removed. Even worse, his accountant tells him that the qualified funding distribution he made form his IRA in 2016 has been disqualified due to something called a Testing Period – Medicare made him ineligible for HSA contributions for 2017. That money is being taxed and penalized as well. Paul woefully reviews his financial statements and is upset as he thought he was doing everything by the book. Thinking it over, he considers booking a few reunion shows with his band mates back in LA.

How to Manage your HSA with Medicare Part A

Given the fact that Medicare Part A can retroactively disqualify you from being HSA eligible, it is best to prepare for such an event and plan accordingly. This involves a combination of 1) knowing if you are at risk for retroactive coverage and 2) planning your preceding and current HSA actions appropriately. As such, we recommend the following:

Determine when you will use Medicare Part A

If you are in your 60’s, you should be thinking about when you will sign up for Medicare Part A coverage, keeping in mind that this is also triggered by beginning Social Security benefits. If this occurs when you are age 65 and 1/2 or older, you are in the danger zone of having retroactive coverage applied. If this is the case, you will want to work backwards 6 months to plan your HSA accordingly. Will the 6 months fall within 1 tax year? Or is it possible that the 6 months will straddle 2 different tax years? By my count, the latter could affect HSA decisions you make up to 18 months in advance of enrollment!

Recalculate and Reduce HSA Contributions

If Medicare Part A applies retroactive coverage and makes you HSA ineligible for those months, you need to reduce your HSA contributions for that time frame. Remember, you are not HSA eligible if you are on Medicare, and thus cannot contribute to your HSA during those months. Instead you need to make a calculate your contribution limit for partial year coverage. For example, if you are 66 years old and have HSA eligible insurance for all of 2017, but then enroll in Medicare in December, you really were only HSA eligible for 5 of those months (since the final 6 months will have Medicare coverage). As a result, you can only contribute 5/12 of your HSA contribution maximum for that year. Many people get tripped up by contributing the full year amount early in the year, which leads to excess contributions once Medicare hits. Save yourself the headache and calculate your “true” maximum contribution early on and conservatively contribute that amount, knowing that you have until tax day to make prior year contributions.

Avoid the Last Month Rule and Qualified Funding Distributions

Retroactive Medicare Part A coverage wrecks the most havoc on HSA contributions that contain a Testing Period. These include the use of the Last Month Rule (to contribute more than normal in a partial coverage year) or the Qualified Funding Distribution (contribute to your HSA from an IRA). Both of these contributions require that you maintain HSA coverage for a given amount of time known as the Testing Period (up to 1 year). The risk is that do everything right and maintain HSA eligible coverage through the Testing Period, but then Medicare comes in and applies retroactive coverage. This in fact fails you for the entire Testing Period if you have Medicare coverage for even 1 month of it. And the worst part is that the penalties for this are fairly severe. They involve walking back your contribution amount, adding it to income, and applying a tax on top of it. You will want to carefully consider the timing of these types of contributions if you are over 65 and considering Social Security or Medicare Part A enrollment.

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