Generally, you cannot treat insurance premiums as qualified medical expenses unless the premiums are for:
a. Long-term care insurance, subject to IRS mandated limits based on age and adjusted annually (see IRS Publication 502: Long-Term Care).
b. Healthcare continuation coverage (such as coverage under COBRA – see IRS Publication 502: COBRA Premium Assistance.
c. Healthcare coverage while receiving unemployment compensation under federal or state law.
d. Medicare and other healthcare coverage if you are 65 or older (other than premiums for a Medicare supplemental policy, such as Medigap).
For (b) and (c) above, your HSA can be used for your spouse or a dependent meeting the requirement for that type of coverage. For (d) above, if you, the account beneficiary, are not 65 years of age or older, Medicare premiums for coverage of your spouse or a dependent (who is 65 or older) generally are not considered a qualified medical expenses.