Can you pay health insurance premiums from an HSA?
Usually not. An HSA can’t pay health insurance premiums, except for long-term care insurance, COBRA, coverage while on unemployment, and Medicare once you are 65.
The rule
Premiums are where an HSA is stricter than the medical expense deduction. On Schedule A, premiums for medical coverage count. From an HSA, insurance doesn’t, with four exceptions in Publication 969: qualified long-term care insurance, up to a limit by age; health care continuation coverage such as COBRA; health coverage while you receive unemployment compensation; and Medicare and other health coverage once you are 65, but not a Medigap policy.
Since 2026 the monthly fee for a direct primary care practice can be paid from an HSA as well. It isn’t treated as insurance.
- What to keep
- For the exceptions, the premium statements and, for unemployment, proof of the benefits.
- Watch for
- If you work for yourself, your premiums may come off your income another way, through the self-employed health insurance deduction.
Checked on October 2, 2026 against Publication 969, Health Savings Accounts, Publication 502, Medical and Dental Expenses and Notice 2026-5, HSAs under the One, Big, Beautiful Bill. An estimate for your records, not tax advice.
Keep the receipt. Take the money out later.
Pay a medical bill yourself and Reimburse keeps the receipt, with who it was for, until you take the money out of your HSA tax-free.