A Health Savings Account (HSA) can be a valuable asset in your estate. Contributions to an HSA are pretax or tax-deductible, the funds grow on a tax-deferred basis, and withdrawals for qualified medical expenses are tax-free.

HSA balances may be carried over from year to year, continuing to grow on a tax-deferred basis indefinitely. Over time, this can allow HSAs to accumulate substantial value (if significant withdrawals aren’t taken to pay medical expenses). There can be major tax consequences for the designated beneficiary who inherits an HSA, so if you have an HSA, it’s important to carefully factor it into your estate planning.

Breaking down the numbers

If you’re covered by a qualified high-deductible health plan (HDHP), you can contribute pretax income to an employer-sponsored HSA—or make deductible contributions to an HSA that you open for yourself—up to applicable limits.

For 2026, an HDHP is a plan with a minimum deductible of $1,700 ($3,400 for family coverage) and maximum out-of-pocket expenses of $8,500 ($17,000 for family coverage). Under the One Big Beautiful Bill Act, signed into law July 4, 2025, the definition of HDHP is expanded beginning in 2026 to include bronze and catastrophic plans.

You can’t contribute to an HSA if you’re covered by any non-HDHP insurance or enrolled in Medicare. However, if you already have an HSA from a time when you were eligible to contribute, you can continue to withdraw funds tax-free to pay for qualified expenses.

For 2026, the annual contribution limit for HSAs is $4,400 for individuals with self-only coverage and $8,750 for individuals with family coverage. If you’re 55 or older, you can add another $1,000. Typically, contributions are made by individuals, but some employers contribute to employees’ accounts.

An HSA can bear interest or be invested, growing tax-deferred, similar to a traditional IRA. After age 65, you can take penalty-free distributions to use for nonmedical expenses, but they’ll be taxable.

Estate planning implications

Because an HSA’s account balance (less any funds used to pay qualified medical expenses) continues to grow on a tax-deferred basis indefinitely, an HSA can provide significant additional assets for your heirs. However, the tax implications of inheriting an HSA differ substantially depending on who receives it, so it’s important to carefully consider your beneficiary designation.

If you name your spouse as a beneficiary, the inherited HSA will be treated as his or her own HSA. That means your spouse can allow the account to continue growing tax-deferred and withdraw funds tax-free for his or her own qualified medical expenses.

If you name your child or someone other than your spouse as a beneficiary, the HSA terminates, and your beneficiary is taxed on the account’s fair market value. Note, however, that any of your qualified medical expenses paid with HSA funds within one year after death aren’t taxable to the HSA beneficiary.

If your estate is the beneficiary of the HSA, the full amount of the HSA is taxed to you in the year of death. In some situations (if you’re in a low tax bracket and the beneficiary is in a high tax bracket, for instance), this may be a good tax planning strategy. However, in others (if you’re in a high tax bracket and your beneficiary is in a low tax bracket), it could be a bad idea tax-wise. As with most tax planning issues, be sure to consider the tax consequences and other relevant factors when making a beneficiary designation.

Also, keep in mind that, if you do have qualified medical expenses during your life, it generally will be more tax efficient for you to use tax-free HSA distributions to pay them. You won’t have to tap non-HSA funds for medical expenses, leaving you with more non-HSA assets to pass on to your non-spouse heirs. For those heirs, the income tax treatment of non-HSA assets will typically be more favorable.

Have questions?

An HSA is a tax-efficient way to fund your health care expenses during your life while helping you build more assets to pass on to your heirs. However, careful planning is critical, especially regarding HSA beneficiary designation. Contact us to discuss how to incorporate an HSA into your estate plan.

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