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Medicare

Q&A: Can I use health savings account to pay Medicare premiums?

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Dear Liz: I’m 65. Can I use a health savings account to pay my Medicare premiums? I do not collect Social Security yet.

Answer: If you already have an HSA, then yes, you can make tax-free withdrawals from it to pay your Medicare premiums. Once you enroll in Medicare, though, you won’t be able to make further contributions to an HSA.

HSAs allow people with high-deductible health insurance plans to save money for current or future medical costs. These accounts offer a rare triple tax advantage: contributions are deductible, the funds grow tax deferred and withdrawals are tax free if the account owner has incurred eligible expenses. Since the funds can be invested and the balance rolled over from year to year, many HSA owners treat these accounts as a supplemental way to save for retirement.

It’s important, though, that the account owner ultimately uses these funds. Although a spouse can inherit an HSA and treat it as their own, any other beneficiary would face income taxes on the balance.

Once you’re 65, you can withdraw HSA money for any reason and not face penalties, but you will be taxed on the withdrawals if they don’t meet the rules for qualified medical expenses.

For example, you can take tax-free withdrawals to pay premiums for the various parts of Medicare: Part A (hospital coverage, which is free for most people), Part B (doctor’s visits), Part C (Medicare Advantage), and Part D (prescription drug coverage). The premium for a Medicare supplemental policy, though, isn’t considered to be a qualified medical expense, so you’d owe taxes on any withdrawal for that.

Premiums for other health insurance policies typically don’t qualify for tax-free withdrawals, with a few exceptions, such as paying for COBRA continuation coverage.

Keep in mind that you can use previous years’ medical expenses to justify a tax-free withdrawal, as long as the unreimbursed expense occurred after opening your HSA. You’ll want to keep receipts and other records showing that the expenses qualified and you haven’t been reimbursed (through an insurance claim, for example).

Q&A: Medicare premium increase offsets cost-of-living boost

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Dear Liz: My wife and I are well over 70 and receive Social Security. We pay for Medicare Part B as well as IRMAA (Income-Related Monthly Adjustment Amount) for Part B and Part D via deductions from our monthly checks. We just received our annual notice from the Social Security Administration of the 2.8% cost-of-living increase for 2026. At the same time, our Medicare deductions were increased such that we ended with a monthly $20 increase in Social Security for my wife and $80 for me. That hardly goes along with the sentence in the standard letter from the SSA that the COLA helps us keep up with the cost of living. Are we just lucky that our monthly checks from the government did not actually decrease?

Answer: In a word, yes.

The cost of healthcare and healthcare insurance typically rises faster than the general rate of inflation. Medicare costs haven’t increased as quickly as those for private insurance. However, it’s still not unusual for higher Medicare premiums to wipe out Social Security cost-of-living increases for the year.

Fortunately, you have other resources to help you cope with inflation. IRMAA is a Medicare surcharge that kicks in for people with modified adjusted gross incomes over $109,000 if single or $218,000 if married filing jointly. The surcharge is determined by your income tax return from two years ago, so your 2026 IRMAA is based on your 2024 filing.

Q&A: Approaching retirement? Don’t count on rules of thumb

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Dear Liz: I have a few questions about my income taxes during my upcoming retirement. I would like to know if doing a Roth IRA conversion will be worth it for me since I might be in a higher tax bracket when I retire. Is there a rule of thumb in regards to doing this conversion? I’m also getting considerable income from my tax-free municipal bond and money market fund. Will that income be taxable when I retire and will it count toward how the government calculates my Medicare premiums?

Answer: Rules of thumb can be incredibly helpful in many areas of personal finance. Guidelines such as “spend less than you earn” and “pay yourself first” apply to virtually everyone. Even more specific recommendations, such as the 50/30/20 budget, can apply to many if not most situations. (The 50/30/20 budget recommends limiting “must have” expenses to 50% of after-tax income, leaving 30% for wants and 20% for savings and extra debt repayment.)

As you enter retirement, though, you’ll be making decisions that may be irreversible. It can be much harder to rebound from mistakes and you’ll have fewer years to do so. That’s why it’s important to get individualized advice from pros you can trust.

Converting a regular retirement account to a Roth IRA can make sense if you expect to be in a higher tax bracket in retirement and can pay the taxes on the conversion without raiding the account. But the conversion also can trigger higher Medicare premiums.

The same is true for municipal bond interest. Muni bond interest typically avoids income tax, but will be included in Medicare premium calculations and may cause more of your Social Security benefit to be taxable as well.

A tax pro can advise you about these issues and offer strategies to lower your lifetime tax bills.

Q&A: Time to move, but what about the capital gains?

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Dear Liz: My husband and I built a home on a hillside over 30 years ago in a desirable neighborhood with a beautiful view. We thought it would be our retirement home, but life had different plans. Now seniors, dealing with age, stairs and progressive health issues, we have been advised that selling and moving to a senior assisted living facility is the best option for us before we are forced by circumstances to move. And, we were told, it would be less expensive than having full-time, in-home care.

We are concerned that capital gains would take a big chunk out of the sales proceeds from our home, and that’s money we need to pay for assisted living. Can we use the purchase price of the vacant lot against the capital gains? Can we use the bank loan for building the house against the capital gains? Can we use the cost of an apartment or condo in an assisted living residence against the capital gains? What other things can be used against capital gains other than general home improvements?

Answer: A large gain wouldn’t just reduce the amount of money you have for the next phase of your life. It also could increase your Medicare premiums for a year, thanks to the income-related adjustment amount or IRMAA.

You’ll determine your potentially taxable capital gains by deducting your tax basis from your home sales proceeds. Your basis includes the purchase price of the lot and the cost of construction, plus any qualifying home improvements you’ve made over the years.

The two of you can shelter up to $500,000 of home sales profits from capital gains taxes. Capital gains also can be reduced if you have capital losses — in other words, if you’ve sold stocks or other assets for a loss.

What you do with money doesn’t affect the capital gains taxes you pay. Decades ago, you could defer capital gains by buying another home of equal or greater value, but that’s no longer the case.

You may have some alternatives to lessen the impact of the gains, such as an installment sale where the buyer pays over time. Another option would be renting out rather than selling your home.

A tax pro can provide guidance.

Q&A: Sale of last home can trigger capital gains taxes

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Dear Liz: I am 74 and my husband is 68. We have decided to sell our last home and rent. Do we have to pay taxes, specifically capital gains, on the sale of our last home or are we able to keep the sale proceeds in full?

Answer: Any home sale is potentially subject to capital gains taxes. Your gain is determined by subtracting your tax basis — the price you paid for the home, plus any qualifying improvements — from the net sales proceeds. If you owned and lived in the home as your primary residence for at least two of the previous five years, you can exclude up to $250,000 (or $500,000 if married filing jointly) of home sale profits. You would owe taxes on the capital gains that exceed those limits.

A large-enough capital gain could affect how much you pay for Medicare. The “income-related adjustment amount,” or IRMAA, is based on your income two years prior, so a big gain in 2025 could increase your premiums in 2027.

You’d be smart to talk to a tax pro before you sell so you understand the ramifications.