Yes — from age 65 on, you can use health savings account (HSA) money to pay Medicare premiums, and that includes IRMAA, the income-related surcharges added to Part B and Part D for higher-income beneficiaries. The IRS treats Medicare premiums as qualified medical expenses for HSA owners age 65 and older, so those withdrawals come out entirely tax-free.
Revised: 7/24/26
Jason Baar
Fee-Only Medicare Advisor
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It covers Roth conversions, capital gains, home sales, filing status, and HSAs — with the 2026 bracket lines and worked examples.
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The long answer
There is a quiet second benefit. HSA withdrawals for qualified expenses never enter adjusted gross income, so paying premiums from the HSA does not raise the modified adjusted gross income that determines future surcharges — unlike paying them from a traditional-IRA withdrawal, which does. Surcharges begin once that figure passes $109,000 for a single filer or $218,000 for a joint filer, per the Social Security Administration.
The mechanics take one extra step. Part B premiums and IRMAA are usually deducted from a Social Security payment or billed by Medicare directly, so you typically pay first and then reimburse yourself from the HSA. Keep the premium statements with your tax records.
Two boundaries to respect: contributions must stop once you are enrolled in any part of Medicare, and using the HSA changes which pocket the surcharge comes from — it does not shrink the surcharge itself. Lowering IRMAA is a separate exercise in managing taxable income.
Printed from JasonKnowsMedicare.com — “Can I Use an HSA to Pay IRMAA?”. The free “Before You Sell the House or Convert That IRA” guide is available at tally.so/r/0QgAAZ · Questions: (850) 810-1000
This page is educational information, not personal financial, tax, or legal advice. For decisions about your own situation, talk with a qualified professional.