Tag Archives: Medicare

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.

An HSA + Medicare Part A Nightmare Example

Here’s an example of how bad this can go. Paul turns 65 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 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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What Happens to Your HSA When Your Plan Changes

Your Health Savings Account remains yours no matter what happens in life, but how you use it can vary depending on the event. This post lists the following events related to changing jobs, retirement, and old age and describes what happens to your HSA when they occur.

What happens to your HSA when you switch plans?

With as crazy as the job market and health care is nowadays, there is a good chance that your insurance plan will change in the future. The key is to understand your new insurance and if it is HSA eligible. During sign up or open enrollment, many plans will explicitly say “HSA eligible” as it is a selling point for many. Look for that indicator, but even if is not called out, your plan may still be HSA eligible. To determine this, you only need to confirm that your plan fits within the HSA requirements for 1) minimum deductible and 2) maximum out of pocket limit. If this is true, then your plan is HSA eligible and you can carry on as before.

If your plan is not HSA eligible, you will not be able to make further contributions to it.

  • Health Savings Account – Any previously allocated funds remain yours and can be spent on qualified medical expenses.
  • Contributions – If your plan is HSA eligible, you can contribute the single/family amount for that year. If your new plan is not HSA eligible, you cannot make further contributions for those months you did not have HSA eligible coverage.
  • Distributions – You may spend your existing HSA dollars on any qualified medical expense.

What happens to your HSA when your job changes?

Since your health insurance generally related to your job, changing jobs almost always changes your health insurance plan or provider. As such, this situation has similar implications to the above section and the key is to determine if your new health insurance is HSA eligible or not.

  • Health Savings Account – Any previously allocated funds remain yours and can be spent on qualified medical expenses, even if your new job does not offer HSA eligible health insurance plans.
  • Contributions – If your new job’s plan is HSA eligible, you can contribute the single/family amount for that year. If the new plan is not HSA eligible, you cannot make further contributions for those months you did not have HSA eligible coverage. Remember that you can contribute pro rata for months that you did have HSA eligible insurance. So if you change jobs in July to no HSA coverage, but had HSA eligible insurance from January – June, you can contribute 6/12 or 1/2 of that year’s contribution limit.
  • Distributions – You may spend your existing HSA dollars on any qualified medical expense.

What happens to your HSA when you are terminated/fired?

We have all been there: for whatever reason your job is not working out so you quit or are laid off / fired / let go. This sucks, but you have to be smart and manage your health insurance as you find your next job. The key is to remain covered so that an unexpected health insurance bill does not become your responsibility (e.g. an unexpected appendicitis results in a $25k medical bill).

One option you may be presented is continuing your existing (HSA) coverage under COBRA insurance offered by your previous employer. COBRA coverage functions as a continuation of your coverage, so it will maintain HSA eligibility if your plan is HSA eligible. Thus, you can continue making HSA contributions under COBRA insurance.

If you have to find new insurance, see the first section on switching your plan, as the new plan’s HSA eligibility will determine whether you can continue contribution or not.

  • Health Savings Account – Any previously allocated funds remain yours and can be spent on qualified medical expenses. Note that while you are receiving unemployment benefits, your HSA can be spent on health insurance premiums (see: How to use your HSA when Unemployed).
  • Contributions – While you may not want to make HSA contributions while unemployed, you certainly can if you are covered by HSA eligible insurance. This might be COBRA insurance or coverage you get on your own.
  • Distributions – You may spend your existing HSA dollars on any qualified medical expense, including health insurance premiums while receiving unemployment benefits.

TrackHSA record keeping

What happens to your HSA when you retire?

Congratulations, you’ve made it! Your Health Savings Account will still be with you at retirement, and there is no need to spend it or withdraw it for any reason. In fact, you can continue making contributions as long as you have HSA eligible insurance and are not on Medicare. If you are over age 55, you can also make catch up contributions which are generally an additional $1,000 on top of your normal contribution amount.

If you are over age 65, a special benefit of Health Savings Accounts begins. At this age, you can use HSA funds for anything, not just qualified medical expenses. That’s right, you can make penalty free distributions for any reason. This is how HSA’s can function as a back door retirement vehicle. Before age 65, if you spend your HSA on non qualified medical expenses, you will owe tax (to undo the tax benefit you receive) and penalty. After 65, you will only owe tax on those dollars not spent on medical expenses (no penalty). This functions just like a traditional (pre tax) IRA, just as another vehicle. That said, it might make most sense to keep the HSA for any medical expenses that arise, since that will of course be tax free.

  • Health Savings Account – This remain yours just as before.
  • Contributions – If you have HSA eligible insurance, you can make contributions. You cannot contribute if you are on Medicare.
  • Distributions – Of course, HSA monies can be spent on qualified medical expenses, or if you are over 65, on anything you like (but you must pay tax).

What happens to your HSA when you begin Medicare?

You cannot contribute to your HSA for any month that you are receiving Medicare benefits. However, if you start Medicare in September and had HSA eligible coverage from January – August, you can still contribute 8/12 or 3/4 of your yearly contribution limit. But if your spouse is under 65 you could always contribute to their HSA to continue funding an account.

The good news is that you can use your Health Savings Account to pay for Medicare A, B, D and Medicare HMO premiums. These count as qualified medical expenses so they are tax and penalty free. If you pay for premiums directly through Social Security, you can transfer (pre-tax) money in your HSA to you bank account to reimburse yourself, effectively paying for them with your HSA.

  • Health Savings Account – This remain yours just as before.
  • Contributions – You cannot make contributions if you are receiving Medicare benefits.
  • Distributions – Your HSA can still be spent on qualified medical expenses, and Medicare A, B, D and HMO premiums count as qualified medical expenses. if you are over 65, you can spend your HSA on anything you like, but treated it will be treated as income and taxed.

What happens to your HSA when you die?

It is important to name an account beneficiary for your Health Savings Account. Otherwise, your HSA will be treated as part of your estate and taxed. If you name your spouse as the account beneficiary, the HSA transfers to them ans remains an HSA, offering them all of the benefits of the account. They are not required to maintain HSA eligible insurance and can use the HSA funds for qualified medical expenses, or if they are over 65, for anything they like.

If someone other than your spouse is named as the HSA account beneficiary, your HSA will be closed and the monies will be distributed and taxed to the beneficiary. However, there is a special provision that allows the beneficiary to spend the HSA funds on the deceased’s medical costs, for up to one year after death. That allows them to spend the money tax free and avoid further taxes from the government.

  • Health Savings Account – Passes to beneficiary. If beneficiary is your spouse, remains an HSA. If beneficiary is not your spouse, it is closed and taxed.
  • Contributions – No further contributions. The exception is if the HSA transfers to your spouse, who is also HSA eligible, and can thus contribute.
  • Distributions – If transferred to spouse, the account continues to function as an HSA. If not, your final medical expenses can be paid using the HSA for up to 1 year. The remaining account is liquidated to the beneficiary and taxed.