If you are under 65 years old, you will have to pay ordinary income taxes as well as pay a 20% penalty for the amount you disbursed out of your HSA account. If you are 65 or older, disabled or die, then you will just pay ordinary income taxes (no penalty).
If you find yourself in this situation, you can attempt to put money back into your HSA funds before tax time each year.
Source: Internal Revenue Code 223, Health Savings Accounts
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