You will be asked to designate a beneficiary when you set up your HSA. If your spouse is the designated beneficiary, then the HSA will be treated as your spouse's after your death. If you designated anyone other than your spouse as the beneficiary, then after your death the account will no longer be an HSA and the beneficiary will be taxed based on the account's fair market value in the year of your death. If your estate is the beneficiary, then the value of the account will be included on your final income tax return.

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