Instructions For Form 8853 - Archer Msas And Long-Term Care Insurance Contracts - 2005 Page 2
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8provided at the top of the form and skip
including contributions for 2005 made
contributions if you can be claimed as a
Part II.
from January 1, 2006, through April 17,
dependent on someone else’s 2005 tax
•
On line 8a, enter the fair market value
2006. Otherwise, check the “No” box on
return.
of the Archer MSA as of the date of
line 2a.
Employer Contributions to an
death.
Lines 1b and 2b
•
Archer MSA
On line 9, for a beneficiary other than
Check “Yes” on line 1b or 2b only if the
the estate, enter qualified medical
If an employer made contributions to your
account holder is considered previously
expenses incurred by the account holder
Archer MSA, you are not entitled to a
uninsured.
before the date of death that you paid
deduction. If you and your spouse are
within 1 year after the date of death.
covered under an HDHP with family
An account holder is considered
•
Complete the rest of Part III.
coverage and an employer made
previously uninsured if the HDHP
contributions to either of your Archer
coverage began after June 30, 1996, and
If the account holder’s estate is the
MSAs, neither you nor your spouse are
the account holder has:
beneficiary, the value of the Archer MSA
allowed to make deductible contributions
as of the date of death is included in the
1. Self-only coverage under an HDHP
to an Archer MSA. If you and your spouse
account holder’s final income tax return.
and did not have any health plan
each have an Archer MSA with self-only
Complete Form 8853 as described above,
coverage at any time during the 6-month
coverage and only one of you received
except you should complete Part II, if
period before coverage under the HDHP
employer contributions to an Archer MSA,
applicable.
began, or
the other spouse is allowed to make
2. Family coverage under an HDHP
The distribution is not subject to the
deductible contributions to an Archer
and neither the account holder nor the
additional 15% tax. Report any earnings
MSA.
account holder’s spouse had any health
on the account after the date of death as
plan coverage at any time during the
income on your tax return.
How To Complete Part II
6-month period before coverage under
Complete lines 3 through 7 as instructed
Deemed Distributions From Archer
the HDHP began.
on the form unless 1 or 2 below applies.
MSAs
In determining whether an account
1. If employer contributions to an
The following situations result in deemed
holder is previously uninsured, disregard
Archer MSA prevent you from taking a
distributions from your Archer MSA.
any health insurance that is permitted in
•
deduction for amounts you contributed to
You engaged in any transaction
addition to the HDHP. See Other Health
your Archer MSA, complete Part II as
prohibited by section 4975 with respect to
Coverage on page 1.
follows.
any of your Archer MSAs, at any time in
a. Complete lines 3 and 4.
2005. Your account ceases to be an
Lines 1c and 2c
b. Skip lines 5 and 6.
Archer MSA as of January 1, 2005, and
If covered by a self-only HDHP and a
c. Enter -0- on line 7.
you must include the fair market value of
family HDHP, indicate which plan was in
d. If line 4 is more than zero, see
all assets in the account as of January 1,
effect longer during the year.
Excess Contributions You Make
2005, on line 8a.
•
on page 4.
You used any portion of any of your
Part II—Archer MSA
2. If you and your spouse have more
Archer MSAs as security for a loan at any
Contributions and
than one Archer MSA, complete Part II as
time in 2005. You must include the fair
follows.
market value of the assets used as
Deductions
security for the loan as income on Form
a. If either spouse has an HDHP with
Use Part II to figure:
1040, line 21.
family coverage, you both are treated as
•
Your Archer MSA deduction,
having only the family coverage plan.
Any deemed distribution will not be
•
Any excess contributions you made,
Disregard any plans with self-only
treated as used to pay qualified medical
and
coverage.
expenses. Generally, these distributions
•
Any excess contributions made by an
b. If both spouses have HDHPs with
are subject to the additional 15% tax.
employer (see Excess Employer
family coverage, you both are treated as
Contributions on page 4).
having only the family coverage plan with
Part I—General
the lowest annual deductible.
Figuring Your Archer MSA
Information
c. If both spouses have HDHPs with
Deduction
self-only coverage, complete a separate
Complete this part if contributions were
The amount you can deduct for Archer
Form 8853, Section A, Part II, for each
made for 2005 by:
•
MSA contributions is limited by:
spouse. Enter “statement” across the top
You (or your employer) to your Archer
•
The applicable portion of the HDHP’s
of each Form 8853, fill in the name and
MSA, or
•
annual deductible (line 5), and
SSN, and complete Part II. Next, add
Your spouse (or his or her employer) to
•
Your compensation from the employer
lines 3, 4, and 7 from the two statement
your spouse’s Archer MSA (if you are
maintaining the HDHP (line 6).
Forms 8853 and enter those totals on the
filing a joint return).
respective lines of the controlling Form
Any employer contributions made to
Lines 1a and 2a
8853 (the combined Form 8853 for both
your Archer MSA prevent you from
spouses). Do not complete lines 5 and 6
Check “Yes” on line 1a if you or your
making deductible contributions. See
of the controlling Form 8853. Attach the
employer made contributions to your
Employer Contributions to an Archer MSA
two statement Forms 8853 to your tax
Archer MSA for 2005, including
on this page. Also, if you or your spouse
return after the controlling Form 8853.
contributions for 2005 made from January
made contributions in addition to any
1, 2006, through April 17, 2006.
employer contributions, you may have to
Otherwise, check the “No” box on line 1a.
pay an additional tax. See Excess
Line 3
Contributions You Make on page 4.
Check “Yes” on line 2a if you are filing
Employer Contributions
a joint return and your spouse (or your
You cannot deduct any contributions
spouse’s employer) made contributions to
you made after you became enrolled in
Employer contributions include any
your spouse’s Archer MSA for 2005,
Medicare. Also, you cannot deduct
amount an employer contributes to any
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