Can my wife use my HSA to pay for a medical bill from before our marriage?

You're asking a great question about HSA rules. Unfortunately, the answer isn't in your favor. HSA funds can only be used for qualified medical expenses of your spouse beginning on the date you're legally married. The IRS is pretty strict about this - since the medical service occurred before your marriage, it wouldn't qualify as an eligible expense from your HSA. If you used your HSA funds to pay for it, the withdrawal would be considered a non-qualified distribution, meaning you'd have to pay income tax on that amount plus a 20% penalty. The timing of payment doesn't matter - what matters is when the medical service was provided. Since the service date was October 2024 and you weren't married until February 2025, it falls outside the qualified expense window.

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There's actually a potential workaround for this situation! Your wife could open her own HSA account now (if she's eligible with a qualifying high-deductible health plan), make a contribution, and then use those funds for her old bill. The HSA doesn't care when the expense was incurred as long as the account existed after the expense. The catch is she would need to be HSA-eligible now to open an account, and there are annual contribution limits. But this could be a way to still get the tax advantage for that old bill.

I work in benefits administration and deal with HSAs daily. Everyone here is correct that you cannot use your HSA for your wife's pre-marriage expenses. However, here's something nobody mentioned - check if her old insurance plan allows claims submission for an extended period! Many plans have a run-out period of 90 days to 1 year where you can still submit claims for services during your coverage period. If she had an FSA or HRA with her old employer, she might still be able to get reimbursed that way.

As someone who went through a similar situation last year, I can confirm what others have said about the HSA rules being strict on timing. The IRS really does care about when the medical service was provided, not when you pay for it or when you got married. However, I'd suggest your wife contact the medical provider's billing department to see if they offer payment plans or financial hardship programs. Many hospitals and clinics have options to reduce the bill or set up interest-free payment arrangements, especially for bills that are several months old. Some will even accept a settlement for less than the full amount if you explain the financial situation. Also, since she had "crappy insurance" at the time, it might be worth having her double-check that the claim was processed correctly with her old insurance. Sometimes claims get denied incorrectly or there are coding errors that can be appealed even months later.