Health savings accounts could play a crucial and tax-advantaged role for clients’ medical costs in retirement, but holding them until age 65 and beyond poses some complexities as well.

The trifecta of pretax contributions, untaxed accumulation and duty-free withdrawals for qualified medical expenses in the accounts open to those with high-deductible health insurance may pay off extra in retirement — as long as financial advisors and their clients keep Medicare rules in mind and avoid a possible tax hit to non-spouse heirs in their estate plans, experts said. That’s because HSA withdrawals do not affect the calculation of taxes on Social Security benefits and aren’t subject to required minimum distributions like traditional individual retirement accounts.

READ MORE: These common HSA mistakes can cost clients 

Advisors and their clients can count on having plenty of uses for their HSAs: the average 65-year-old who retired last year could spend $165,000 on health care during retirement, according to Karen Volo, the head of health and benefit accounts at Fidelity Investments.

“Paying medical expenses in retirement should be a part of every planning conversation, given the burden of expense in retirement.  And there is no more advantageous way to prepare for those expenses than an HSA,” Volo said in an email. “Once you turn 65, you can use your HSA to pay for other nonqualified medical expenses, too. You’ll have to pay applicable state and federal taxes on these withdrawals, but this gives you another option for retirement income should you need it.”

The 20% penalty that would normally apply to the nonmedical use of the assets goes away once the client is over 65, noted Heather Schreiber, the founder of advanced planning consulting firm HLS Retirement Consulting. However, if the client decides to enroll in Medicare when they first reach eligibility at 65, they could risk paying a 6% excise tax for excess HSA contributions if they do not cut off the payments before joining Medicare, she said. 

On the other hand, they could also reap savings on the taxes for Social Security benefits by drawing from their HSAs for health expenses in retirement, due to the formula dictating those duties.

“HSAs are one of the few sources of income that don’t hit the provisional income calculations, so it’s a wonderful source,” Shreiber said. “Everyone’s concerned about the rising cost of health care and the potential for long-term care.”

READ MORE: Only 1 HSA provider rated ‘high’ quality by Morningstar. Here’s why

She and Volo each described clients’ immediate healthcare needs prior to retirement as the key challenge confronting their efforts to set aside their HSAs until retirement. Ideally, each client would contribute as much as possible “up to the yearly maximum to harness the power of compounding with your tax-free HSA dollars,” Volo said.  

“You can always leave a portion of your HSA balance in cash to pay for qualified medical expenses as they arise if you need to,” she said. “On the other hand, it’s not a bad idea to pay for medical expenses with your regular savings if you are able to; just be sure to save the receipts! Much like the account itself, ‘qualified medical expenses’ never expire, either. If you pay for a qualified medical expense out-of-pocket, you can submit saved receipts for reimbursement at any point. Whether it’s two, 12 or 20 years in the future, you can pay yourself back with the tax-free dollars you’ve compounded in your HSA.”

The “tricky” questions surrounding how best to use HSAs in retirement means that advisors should guide clients carefully on the timing of their Medicare enrollment and when to begin collecting their Social Security benefits, Schreiber said. The current standard expenses of more than $2,700 per year for Medicare Part B and D premiums could prove a helpful topic to raise with the clients, alongside the pronounced rate of inflation for health care costs.

“They’re roughly triple what normal inflation is,” she said. “Think about those expenses that you could cover using a health savings account.”

The Whitehouse has cancelled the October 2023 executive order from the previous administration on AI regulation and oversight as one of many such cancellations now that the new administration is in power. 

The executive order generally called for the development of standards and best practices to address various aspects of AI risk, such as for detecting AI-generated content and authenticating official communications. It also directed government agencies to study things such as how AI could impact the labor market and how agencies collect and use commercially available information. It also emphasizes the development of new technologies to protect privacy rights and bolster cybersecurity, as well as training on AI discrimination, and the release of guidance on how different agencies should be using AI. 

The AP noted that many of the items in the original executive order have been fulfilled already—such as numerous studies on things like cybersecurity risks and effects on education, workplaces and public benefits—and so there is not that much to repeal in the first place. 

One key provision that is now gone, however, is the requirement that tech companies building the most powerful AI models share details with the government about the workings of those systems before they are unleashed to the public. Opponents of the executive order had long said it would reveal trade secrets and hamstring US tech companies. 

When the EO was first signed, Alex Hangerup, co-founder and CEO of payment automation and insights solutions provider Vic.ai, said the executive order was a good first step, as its scope was ambitious and comprehensive, though expressed concerns that the order has a lot of moving parts and may be difficult to maintain. Asked about his feelings regarding the repeal, he did not seem especially troubled, noting that players in the AI space should be relying on a collaborative framework versus a top-down bureaucratic approach anyway. 

“AI has the potential to be one of the most transformative forces in modern finance, and fostering innovation in this space is critical. The previous Executive Order was a step toward structured oversight, but any AI regulation must strike a balance—protecting against risk while ensuring we don’t stifle progress. The decision to rescind the order underscores the importance of a more adaptive, market-driven approach to AI governance. Rather than relying on rigid top-down mandates, we need a collaborative framework that evolves with the technology. Responsible AI development doesn’t mean excessive bureaucracy; it means accountability, transparency, and engagement with the businesses actually building these solutions. At Vic.ai, we believe the future of AI in accounting—and across industries—depends on fostering innovation while ensuring AI remains a force for accuracy, efficiency, and trust,” he said. 

Pascal Finette, co-founder and CEO of technology consulting firm “be Radical,” at the time said the order seemed to be crafted by people who didn’t really understand AI much in the first place, and many of its provisions seemed more motivated by fear and worry, pointing to language that infers AI is a weapon which must be controlled. Overall, at the time, he said the order felt far reaching and somewhat reactionary given its focus on foundational models, and said regulation would be much easier applied at the application level. Overall, though, he wasn’t very concerned there would be any direct impacts on the accounting solutions space, as most vendors don’t create their own models but instead rely on those created by other companies that may or may not fall under the executive order. 

When asked what he thought about the repeal, he repeated that many of the original provisions didn’t seem that thought out and so it was good some of the more ill-conceived aspects will be cancelled, though it leaves open questions about sustainability and responsibility. 

“I’d say (with probably anything Trump says or does), it’s too early to tell. On one hand, I think it’s good and useful that we removed this somewhat ill-advised policy; on the other hand, there are huge question marks around the responsible and long-term sustainability of AI and its impact on society and businesses,” said Finette.

Aaron Harris, chief technology officer at practice management solutions provider Sage, said at the time the executive order was signed that it was an important step forward, given the rapid proliferation of AI technologies. He felt at the time that the order sets the appropriate tone for AI development, as it emphasizes safe and responsible uses. Today, he said there is need to simultaneously nurture and support AI innovation while recognizing SMEs need to feel confident they’re working with technology partners who adhere to safe, ethical AI development practices. Harris added that the Trump administration’s decision to cancel the executive order doesn’t change this fundamental relationship.  

“AI remains one of the greatest opportunities of our time. And as AI evolves, it’s expected that governmental policies and regulations around AI will as well. At Sage, our stance remains that AI practices must be ethical and responsible. We are committed to building AI technology for the future that is safe, transparent and trustworthy. As the regulatory landscape evolves, our mission remains clear: to innovate responsibly and empower businesses without compromising ethical standards. In the U.S., I am optimistic that the current administration will continue to create opportunities to evolve and accelerate AI innovation — improving lives and driving economic growth — while staying true to our duty of upholding the highest standards of ethics and trust,” said Harris.

Amy Matsuo, regulatory insights leader at KPMG, noted in a statement that this might lead to increasing divergence between state and federal regulators. She also pointed out that while there is nothing to replace the executive order, companies should still expect some regulatory focus regarding their AI ambitions.  

“As expected, the new Administration has repealed the previous Administration’s 2023 AI Executive Order, but did not immediately initiate a series of net-new AI actions. To drive US leadership in AI, the new Administration is reportedly looking to expand data center and energy capacity and encourage innovative model development and application. Companies should expect regulatory focus on critical security, national security and sensitive data. However, increased divergence with state and global AI- and privacy-related regulatory activity will increase (with a flurry of 2025 state bills already in motion), resulting in a continued regulatory patchwork as well as likely expanded state AG actions

The news comes around the same time that the administration also announced a $500 billion investment in AI technology.

“The $500 billion investment is pretty nuts—I’m not sure if you saw the comparisons, but it’s a multiple of the cost of the whole Apollo program (in today’s dollars),” said Finette. 

The Financial Accounting Standards Board released a proposed accounting standards update containing a set of targeted improvements to the FASB Accounting Standards Codification. 

The amendments in the proposed ASU involve incremental changes to the codification and would affect a wide range of topics. They would apply to all reporting entities within the scope of the affected accounting guidance.

The proposed ASU would address 34 issues, including issues related to:

• Removing the term “amortized cost” from the Master Glossary;
• Clarifying the calculation of earnings per share when a loss from continuing operations exists;
• Clarifying the calculation of the reference amount for beneficial interests;
• Clarifying the guidance for the transfer of receivables from contracts with customers; and,
• Clarifying the accounting for certain receivables by not-for-profit entities.

FASB is asking for comments by April 22, 2025.