Post-65, HSA funds pay Medicare Part B/D/Advantage premiums + LTC insurance premiums tax-free.
After age 65 the 20% HSA non-medical penalty disappears (still ordinary income) but qualified medical expenses remain tax-free. HSAs can pay Medicare Part B, D, and Advantage premiums (NOT Medigap) plus qualified LTC insurance premiums (age-based limits: 61–70 = $4,770/yr, 71+ = $5,960/yr in 2025). Reimburse yourself for years of prior qualified expenses if you kept receipts. Best retirement account for retirees with high healthcare spend.
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Irrevocable income-only trust funded 5+ years before Medicaid application shelters home and assets from spend-down.
Transfer the primary residence to an adult child who lived there caregiving for 2+ years — no Medicaid transfer penalty.
In select states, the well spouse refuses to contribute — Medicaid must cover institutionalized spouse, may sue later.
Wartime-era veterans (or surviving spouses) needing help with ADLs get up to $2,795/mo tax-free — stacks with Medicaid.
Written contract paying an adult child market rate for caregiving spends down assets without Medicaid transfer penalty.
Immediate irrevocable annuity converts spend-down assets into an income stream for the community spouse.
Ladybird deed transfers home at death with §1014 step-up, avoids probate, and doesn't trigger Medicaid transfer.
Combo policies give LTC benefits if needed, death benefit if not — no 'use it or lose it' like standalone LTC.