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In the event that the younger spouse has already reached age 65, themselves, the preference to concentrate contributions in the older spouses HSA can be discarded if contributions are still being made to the HSA (a scenario that would generally require the spouses to be covered by a large employers group plan, or else Medicare would become the couples primary insurer and HSA contributions would no longer be allowed), as the tax treatment for all distributions would now apply equally to both spouses

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The Journal of Lipid Research, 39, 1310-1315