Instructions For Form 8853 - Archer Msas And Long-Term Care Insurance Contracts - 2005 Page 5
ADVERTISEMENT
1
2
3
4
5
6
7
8distributions. Enter on line 11b only 15%
that meets the Medicare guidelines.
The distribution is not subject to the
of the amount of your spouse’s
Contributions to the account can be made
additional 50% tax. Report any earnings
distributions included in line 10.
only by Medicare. The contributions and
on the account after the date of death as
any earnings, while in the account, are
income on your tax return.
Example 3. You turned age 65 in
not taxable to the account holder. A
2005. You received distributions that are
Line 12
distribution used exclusively to pay for the
included in income both before and after
Enter the total distributions you received
qualified medical expenses of the account
you turned age 65. Check the box on line
in 2005 from all Medicare Advantage
holder is not taxable. Distributions that
11a because the additional 15% tax does
MSAs. These amounts should be shown
are not used for qualified medical
not apply to the distributions made after
in box 1 of Form 1099-SA. This amount
expenses of the account holder are
the date you turned age 65. However, the
should not include any erroneous
included in income and also may be
additional 15% tax does apply to the
contributions made by Medicare (or any
subject to a penalty.
distributions made on or before the date
earnings on the erroneous contributions)
you turned age 65. Enter on line 11b,
Death of Account Holder
or any amounts from a trustee-to-trustee
15% of the amount of these distributions
If the account holder’s surviving spouse is
transfer from one Medicare Advantage
included in line 10.
the designated beneficiary, the Medicare
MSA to another Medicare Advantage
Advantage MSA is treated as a regular
MSA of the same account holder.
Section B—Medicare
Archer MSA (not a Medicare Advantage
Line 13
Advantage MSA
MSA) of the surviving spouse for
distribution purposes. Follow the
Enter the total distributions from all
Distributions
instructions in Section A for Death of
Medicare Advantage MSAs in 2005 that
Account Holder that begin on page 1.
were used for your qualified medical
Complete Section B if you (or your
expenses (see page 1).
spouse, if filing jointly) received
If the designated beneficiary is not the
distributions from a Medicare Advantage
account holder’s surviving spouse, or
You cannot take a deduction on
MSA in 2005. If both you and your spouse
there is no designated beneficiary, the
!
Schedule A (Form 1040) for any
received distributions, complete a
account ceases to be an MSA as of the
amount you include on line 13.
CAUTION
separate Form 8853, Section B, for each
date of death. The beneficiary completes
spouse. Enter “statement” across the top
Form 8853 as follows.
Lines 15a and 15b
•
of each Form 8853, fill in the name and
Enter “Death of Medicare Advantage
SSN, and complete Section B. Next, add
MSA account holder” across the top of
Additional 50% Tax
lines 12, 13, 14, and 15b from the two
Form 8853.
Medicare Advantage MSA distributions
•
statement Forms 8853 and enter those
Enter the name(s) shown on your tax
included in income (line 14) may be
totals on the respective lines of the
return and your SSN in the spaces
subject to an additional 50% tax unless
controlling Form 8853 (the combined
provided at the top of the form. Skip
one of the following exceptions applies.
Form 8853 for both spouses). If either
Section A.
•
spouse checked the box on line 15a of
Exceptions to the Additional 50%
On line 12, enter the fair market value
the statement Form 8853, check the box
of the Medicare Advantage MSA as of the
Tax
on the controlling Form 8853. Attach the
date of death.
The additional 50% tax does not apply to
•
two statement Forms 8853 to your tax
On line 13, for a beneficiary other than
distributions made on or after the date
return after the controlling Form 8853.
the estate, enter qualified medical
that the account holder —
•
expenses incurred by the account holder
Dies, or
•
before the date of death that you paid
Medicare Advantage MSA
Becomes disabled (see page 1).
within 1 year after the date of death.
A Medicare Advantage MSA is an Archer
If either of the exceptions applies to any
•
Complete the rest of Section B.
MSA designated as a Medicare
of the distributions included on line 14,
Advantage MSA to be used solely to pay
If the account holder’s estate is the
check the box on line 15a. Next, if either
the qualified medical expenses of the
beneficiary, the value of the Medicare
of the exceptions applies to all the
account holder. To be eligible for a
Advantage MSA as of the date of death is
distributions included on line 14, enter -0-
Medicare Advantage MSA, you must be
included in the account holder’s final
on line 15b. Otherwise, complete the
enrolled in Medicare and have an HDHP
income tax return.
worksheet on page 5 to figure the amount
Additional 50% Tax Worksheet—Line 15b
(Keep for Your Records)
1.
Enter the total distributions included on Form 8853, line 14, that do not meet either of the exceptions
to the additional 50% tax
1.
2.
Did you have a Medicare Advantage MSA on December 31, 2004?
No.
Enter one-half of line 1 on Form 8853, line 15b.
STOP
Yes. Enter the value of your Medicare Advantage MSA on December 31, 2004
2.
3.
Enter the amount of the annual deductible for your HDHP policy
on January 1, 2005
3.
4.
Multiply line 3 by 60% (.60)
4.
5.
Subtract line 4 from line 2. If zero or less, enter -0-
5.
6.
Subtract line 5 from line 1. If zero or less, enter -0-
6.
7.
Enter one-half of line 6 here and on Form 8853, line 15b
7.
-5-
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Financial