Health Care Savings Account Act of 1991

Health Care Savings Account Act of 1991 - Amends the Internal Revenue Code to allow employees and employers, including self-employed individuals, a 60 percent tax credit for contributions to a health care savings account for the benefit of the employee or self-employed individual. Limits total contributions to an account to the aggregate amount of hospital insurance tax paid with respect to the account beneficiary. Describes conditions that must be met by the account.

Excludes from the gross income of the beneficiary any account contributions made by an employer.

Exempts an account from taxation (except for the tax on unrelated business income of a charitable organization) unless the distributee engages in specified transactions in connection with it.

Excludes from gross income any account distributions used to pay the eligible medical expenses of the beneficiary or qualifying spouse.

Imposes a ten percent surtax on account distributions used for other than health care purposes or made before the distributee is aged 65 or older.

Imposes penalty taxes in connection with: (1) excess contributions or prohibited transactions associated with an account; (2) distributions from an account that reduce a distributee's account level below a specified amount; and (3) failure to effect spousal rollover of an account upon the spouse's death.

Imposes penalties for failure to make required reports concerning an account.

Amends title XVIII (Medicare) of the Social Security Act to reduce the Medicare benefits of a health care savings account beneficiary by 60 percent of the maximum amount of Medicare-related expenditures that could be reasonably underwritten (by an insurance company) for the average Medicare beneficiary, given certain assumptions. Establishes special rules for individuals who cannot obtain insurance to cover their added deductible at the standard premium rates.

Directs the Secretary of Health and Human Services to establish rules in connection with recalculations of deductibles when a qualifying spouse becomes eligible for Medicare.

Establishes catastrophic health care expense protection for certain individuals who qualify for Medicare and have met specified contribution requirements with respect to one or more health care savings accounts. Describes conditions under which a qualifying spouse becomes eligible for this protection.