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Death of Account Holder

expenses. Generally, these distributions

Figuring Your Archer MSA

are subject to the additional 15% tax.

Deduction

If the account holder’s surviving spouse is

the designated beneficiary, the Archer

The amount you can deduct for Archer

Part I—General

MSA is treated as if the surviving spouse

MSA contributions is limited by:

•

were the account holder. The surviving

The applicable portion of the HDHP’s

Information

spouse completes Form 8853 as though

annual deductible (line 5), and

•

Complete this part if contributions were

the Archer MSA belonged to him or her.

Your compensation from the employer

made for 2008 by:

maintaining the HDHP (line 6).

If the designated beneficiary is not the

•

You (or your employer) to your Archer

account holder’s surviving spouse, or

Any employer contributions made to

MSA, or

there is no designated beneficiary, the

•

your Archer MSA prevent you from

Your spouse (or his or her employer) to

account ceases to be an Archer MSA as

making deductible contributions. See

your spouse’s Archer MSA (if you are

of the date of death. The beneficiary

Employer Contributions to an Archer MSA

filing a joint return).

completes Form 8853 as follows.

below. Also, if you or your spouse made

•

Enter “Death of Archer MSA account

Lines 1a and 2a

contributions in addition to any employer

holder” across the top of Form 8853.

contributions, you may have to pay an

•

Check “Yes” on line 1a if you or your

Enter the name(s) shown on your tax

additional tax. See Excess Contributions

employer made contributions to your

return and your SSN in the spaces

You Make on page 4.

Archer MSA for 2008, including

provided at the top of the form and skip

contributions for 2008 made from January

You cannot deduct any contributions

Part II.

•

1, 2009, through April 15, 2009.

you made after you became enrolled in

On lines 8a and 8c, enter the fair

Otherwise, check the “No” box on line 1a.

Medicare. Also, you cannot deduct

market value of the Archer MSA as of the

contributions if you can be claimed as a

date of death.

Check “Yes” on line 2a if you are filing

•

dependent on someone else’s 2008 tax

On line 9, for a beneficiary other than

a joint return and your spouse (or your

return.

the estate, enter qualified medical

spouse’s employer) made contributions to

expenses incurred by the account holder

your spouse’s Archer MSA for 2008,

Employer Contributions to an

before the date of death that you paid

including contributions for 2008 made

Archer MSA

within 1 year after the date of death.

from January 1, 2009, through April 15,

•

If an employer made contributions to your

Complete the rest of Part III.

2009. Otherwise, check the “No” box on

Archer MSA, you are not entitled to a

line 2a.

If the account holder’s estate is the

deduction. If you and your spouse are

beneficiary, the value of the Archer MSA

covered under an HDHP with family

Lines 1b and 2b

as of the date of death is included in the

coverage and an employer made

Check “Yes” on line 1b or 2b only if the

account holder’s final income tax return.

contributions to either of your Archer

account holder is considered previously

Complete Form 8853 as described above,

MSAs, neither you nor your spouse are

uninsured.

except you should complete Part II, if

allowed to make deductible contributions

applicable.

to an Archer MSA. If you and your spouse

An account holder is considered

each have an HDHP with self-only

previously uninsured if the HDHP

The distribution is not subject to the

coverage and only one of you received

coverage began after June 30, 1996, and

additional 15% tax. Report any earnings

employer contributions to an Archer MSA,

the account holder has:

on the account after the date of death as

the other spouse is allowed to make

income on your tax return.

1. Self-only coverage under an HDHP

deductible contributions to an Archer

and did not have any health plan

Note. If, during the tax year, you are the

MSA.

coverage at any time during the 6-month

beneficiary of 2 or more Archer MSAs or

period before coverage under the HDHP

How To Complete Part II

you are a beneficiary of an Archer MSA

began, or

and you have your own Archer MSA, you

Complete lines 3 through 7 as instructed

2. Family coverage under an HDHP

must complete a separate Form 8853 for

on the form unless 1 or 2 below applies.

and neither the account holder nor the

each MSA. Enter “statement” at the top of

1. If employer contributions to an

account holder’s spouse had any health

each Form 8853 and complete the form

Archer MSA prevent you from taking a

plan coverage at any time during the

as instructed. Next, complete a controlling

deduction for amounts you contributed to

6-month period before coverage under

Form 8853, combining the amounts

your Archer MSA, complete Part II as

the HDHP began.

shown on each of the statement Forms

follows.

8853. Attach the statements to your tax

a. Complete lines 3 and 4.

In determining whether an account

return after the controlling Form 8853.

b. Skip lines 5 and 6.

holder is previously uninsured, disregard

c. Enter -0- on line 7.

any health insurance that is permitted in

Deemed Distributions From Archer

d. If line 4 is more than zero, see

addition to the HDHP. See Other Health

MSAs

Excess Contributions You Make

Coverage on page 1.

The following situations result in deemed

on page 4.

distributions from your Archer MSA.

2. If you and your spouse have more

Lines 1c and 2c

•

You engaged in any transaction

than one Archer MSA, complete Part II as

If covered by a self-only HDHP and a

prohibited by section 4975 with respect to

follows.

family HDHP, indicate which plan was in

any of your Archer MSAs, at any time in

a. If either spouse has an HDHP with

effect longer during the year.

2008. Your account ceases to be an

family coverage, you both are treated as

Archer MSA as of January 1, 2008, and

having only the family coverage plan.

Part II—Archer MSA

you must include the fair market value of

Disregard any plans with self-only

all assets in the account as of January 1,

Contributions and

coverage.

2008, on line 8a.

b. If both spouses have HDHPs with

•

Deductions

You used any portion of any of your

family coverage, you both are treated as

Archer MSAs as security for a loan at any

Use Part II to figure:

having only the family coverage plan with

time in 2008. You must include the fair

•

Your Archer MSA deduction,

the lowest annual deductible.

market value of the assets used as

•

Any excess contributions you made,

c. If both spouses have HDHPs with

security for the loan as income on Form

and

self-only coverage, complete a separate

1040, line 21; or Form 1040NR, line 21.

•

Any excess contributions made by an

Form 8853, Section A, Part II, for each

Any deemed distribution will not be

employer (see Excess Employer

spouse. Enter “statement” across the top

treated as used to pay qualified medical

Contributions on page 4).

of each Form 8853, fill in the name and

-2-

Instructions For Form 8853 - Archer Msas And Long-Term Care Insurance Contracts - 2008 Page 2

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