Why
Publication 969 says you may not use HSA funds for insurance, and lists four exceptions: long-term care insurance, up to age-based limits; continuation coverage such as COBRA; coverage while receiving unemployment compensation under federal or state law; and Medicare and other coverage if you were 65 or older, other than Medigap. A 2025 law added direct primary care fees.
Publication 502 lets you count many premiums on your tax return, which is a different rule. Before 65, regular employer or marketplace premiums can't come out of an HSA tax-free. At 65 or older, premiums you pay after tax for most health coverage can, except Medigap.
COBRA and unemployment coverage can be for a spouse or dependent who meets the requirement for that coverage.
What to keep
- Premium invoices or statements showing the coverage period.
- COBRA election paperwork.
- For coverage while unemployed, proof of benefits such as Form 1099-G.
Watch out for
- Long-term care premiums are capped by age, and the caps change each year.
If you plan to reimburse yourself later
IRS Notice 2004-50, Q&A 39, sets no deadline, as long as the expense came after your HSA was established and your records show it wasn't paid by another source or deducted on a tax return. See what records the IRS expects and how long to keep them.