@lark5 wrote:
Were you able to find an answer to that variation on the question?
In particular, I am in that situation described where my fiancée has medical debt she incurred long after I opened my account, but prior to our marriage. She has not yet paid the bills for it (and insurance denied most of her claims). Can I use my HSA balance to pay these bills after our marriage?
I see 2 similar questions answered answers here, but different. Together they seem to me to imply that the important dates for it are that paying the bills occurs after the wedding, but that incurring the bills occurs after the account was opened. Thus seeming to imply that I can legally use the HSA to reimburse for any portion of the bills paid after our wedding date?
https://ttlc.intuit.com/community/tax-credits-deductions/discussion/can-i-use-my-hsa-to-pay-for-my-n...
https://ttlc.intuit.com/community/tax-credits-deductions/discussion/hsa-distributions-for-spouse-mid...
I think it is allowed.
While I would generally agree with both the experts in the answers you cite, here they differ, so I did some research. The HSA law (USC §223) does not contain the limitation that expenses must be incurred after the account is opened. That requirement first appears in IRS notice 2004-2. (Side note: because it is not in the law, it may be susceptible to court challenge. I don't know if that has ever happened.)
The HSA law §223 and IRS notice 2004-2 say that the definition of qualified medical expenses for an HSA is the same as for deductible medical expenses under USC §213(d). §213 is implemented by US Treasury Regulation 26 CFR 1.213-1, which says "In the case of medical expenses for the care of a person who is the taxpayer's spouse or dependent, the deduction under section 213 is allowable if the status of such person as “spouse” or “dependent” of the taxpayer exists either at the time the medical services were rendered or at the time the expenses were paid." (Emphasis added)
Since §223 relies on the definition of qualifying expenses from §213, and §213 allows you to deduct expenses incurred by a spouse when paid, even if they were not your spouse when the expense was incurred, then I believe you can also use HSA funds to pay a provider for expenses incurred before the wedding.
However, there are two important caveats here.
1. If your fiancée paid the provider in the past using a credit card or other type of loan, then you can't use the HSA now to pay off the debt or to reimburse your new spouse. The trigger is when the provider is paid, not when the debt is paid off. If you were not married when the expense was incurred and you were not married when the provider was paid, which are the two requirements in the regulation, you can't use the HSA.
2. If your fiancée has not paid the provider, you may pay the provider for her after the wedding, but not before, because once again, if you pay the provider before the wedding, you don't meet either requirement in the regulation.
References
https://www.law.cornell.edu/uscode/text/26/213#d
https://www.law.cornell.edu/cfr/text/26/1.213-1
https://www.irs.gov/pub/irs-drop/n-04-2.pdf
https://www.law.cornell.edu/uscode/text/26/223
https://www.irs.gov/pub/irs-drop/n-04-50.pdf
