Dear Liz: My wife and I, both in our early 90s, are fortunate to have good health insurance. However, we have significant expenses that are not covered. As you might expect, we are retired and receive income from Social Security, pensions, annuities and investments. Are we eligible to use flexible health accounts funded with pretax dollars? If so, what’s the best way to set that up and how would we pay those uncovered health bills?
Answer: Unfortunately, you don’t have access to pretax accounts that could help you pay medical bills.
Flexible spending accounts are offered by employers, and contributions are limited annually (in 2025, the limit is $3,300). Health savings accounts have higher limits but require you to have a qualifying high-deductible health insurance plan. Once you’re on Medicare, as you two presumably are, you are no longer allowed to contribute to an HSA.
You might be able to deduct medical expenses that exceed 7.5% of your adjusted gross income. To claim the deduction, you would need to have enough itemized expenses to exceed the standard deduction, which in 2025 is $34,700 for a married couple filing jointly who are 65 and older. (The standard deduction for a married couple filing jointly is $31,500, while people 65 and older get an additional deduction of $1,600 each.)
There’s also a new, temporary $6,000 deduction for people 65 and older that is available whether you itemize or take the standard deduction. This bonus deduction begins to phase out for adjusted gross income above $150,000 for married couples filing jointly and disappears at AGIs above $250,000. This deduction is set to expire after the 2028 tax year.
Today’s top story: How a home improvement fund can upgrade your new house to a home. Also in the news: Single-income couples, and when to use your FSA and HSA, and how rising inflation could mean your home is underinsured.
Today’s top story: 5 things agents wish people knew about insurance. Also in the news: 10 factors affecting COVID-era travel, how the new stimulus bill will affect unemployment, and how to spend your FSA before the grace period expires. 
Today’s top story: How to plan and budget for DIY projects now. Also in the news: How to factor climate change into your air travel, why it’s probably better to lease a car than buy one right now, and new rules for medical and dependent care FSAs.
Today’s top story: Credit score drop? How to diagnose why and what to do next. Also in the news: A new episode of the SmartMoney podcast on the safety of Bitcoin, what to do if you’re struggling with IRS delays, and what to do about your FSA contributions if your child care is closed.