There are several ways that funds in a health savings account can be withdrawn. Some health savings accounts include a debit card, some supply checks for account holder use, and some allow for a reimbursement process similar to medical insurance. Most health savings accounts have more than one possible method for withdrawal, and the methods available vary. Checks and debits do not have to be made payable to the provider. Funds can be withdrawn for any reason, but withdrawals that are not for documented qualified medical expenses are subject to income taxes and a 20% penalty. The 20% penalty is waived for persons who have reached the age of 65 or have become disabled at the time of the withdrawal. Then, only income tax is paid on the withdrawal and in effect, the account has grown tax-deferred. Medical expenses continue to be tax free. Prior to January 1, 2011, when new rules governing health savings accounts in the Patient Protection and Affordable Care Act went into effect, the penalty for non-qualified withdrawals was 10%.