Instructions For Form 8853 - 2011

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2011
Department of the Treasury
Internal Revenue Service
Instructions for Form 8853
Archer MSAs and Long-Term Care Insurance Contracts
death benefits from a life insurance policy
Qualified medical expenses are those
Section references are to the Internal
on a per diem or other periodic basis in
incurred by the account holder or the
Revenue Code unless otherwise noted.
2011. See the instructions for Section C
account holder’s spouse or dependent(s).
General Instructions
that begin on page 5.
See the instructions for line 7 on page 4.
You (or your spouse, if filing jointly)
However, you cannot treat insurance
After December 31, 2007,
received Archer MSA or Medicare
premiums as qualified medical expenses
!
contributions cannot be made to
Advantage MSA distributions in 2011.
unless the premiums are for:
an Archer MSA for you, unless:
CAUTION
Long-term care (LTC) insurance,
If you (or your spouse, if filing
You were an active Archer MSA
!
Health care continuation coverage, or
jointly) received Archer MSA or
participant for any tax year ending before
Health care coverage while receiving
Medicare Advantage MSA
CAUTION
January 1, 2008, or
unemployment compensation under
distributions in 2011, you must file Form
You became an active Archer MSA
8853 with a Form 1040 even if you have
federal or state law.
participant for a tax year ending after
no taxable income or any other reason for
Note. Non-prescription medicines (other
December 31, 2007, because of coverage
filing Form 1040.
than insulin) purchased in tax years
under a high deductible health plan of an
beginning after December 31, 2010, are
Archer MSA participating employer.
not considered qualified medical
Specific Instructions
What’s New
expenses.
The IRS has created a page on IRS.gov
Name and social security number
High Deductible Health Plan
for information about Form 8853 and its
(SSN). Enter your name(s) and SSN as
An HDHP is a health plan that meets the
instructions, at
shown on your tax return. If filing jointly
following requirements.
Information about any future
and both you and your spouse each have
developments affecting Form 8853 (such
an Archer MSA or each have a Medicare
Self-only
Family
as legislation enacted after we release it)
Advantage MSA, enter the SSN shown
coverage
coverage
will be posted on that page.
first on your tax return.
Minimum annual
Purpose of Form
Section A—Archer MSAs
deductible
$2,050
$4,100
Use Form 8853 to:
Maximum annual
deductible
$3,050
$6,150
Eligible Individual
Report Archer MSA contributions
(including employer contributions),
Maximum annual
To be eligible for an Archer MSA, you (or
Figure your Archer MSA deduction,
out-of-pocket expenses
your spouse) must be an employee of a
Report distributions from Archer MSAs
(other than for premiums)
$4,100
$7,500
small employer or be self-employed. You
or Medicare Advantage MSAs,
(or your spouse) must be covered under a
Report taxable payments from
Other Health Coverage
high deductible health plan (HDHP) and
long-term care (LTC) insurance contracts,
have no other health coverage except
If you have an Archer MSA, you (and your
or
permitted coverage. You must not be
spouse, if you have family coverage)
Report taxable accelerated death
enrolled in Medicare and cannot be
cannot have any health coverage other
benefits from a life insurance policy.
claimed as a dependent on someone
than an HDHP. But your spouse can have
else’s 2011 tax return. You must be an
Additional information. See Pub. 969,
health coverage other than an HDHP if
eligible individual on the first day of a
Health Savings Accounts and Other
you are not covered by that plan.
month to take an Archer MSA deduction
Tax-Favored Health Plans, for more
Exceptions. You can have additional
for that month.
details on MSAs.
insurance that provides benefits only for:
Small Employer
Liabilities under workers’ compensation
Who Must File
A small employer is generally an
laws, tort liabilities, or liabilities arising
You must file Form 8853 if any of the
employer who had an average of 50 or
from the ownership or use of property,
following applies.
fewer employees during either of the last
A specific disease or illness, or
You (or your employer) made
2 calendar years. See Pub. 969 for
A fixed amount per day (or other
contributions for 2011 to your Archer
details.
period) of hospitalization.
MSA.
Archer MSA
You can also have coverage (either
You are filing a joint return and your
through insurance or otherwise) for
spouse (or his or her employer) made
Generally, an Archer MSA is a medical
accidents, disability, dental care, vision
contributions for 2011 to your spouse’s
savings account set up exclusively for
care, or long-term care.
Archer MSA.
paying the qualified medical expenses of
You (or your spouse, if filing jointly)
the account holder.
Disabled
acquired an interest in an Archer MSA or
Qualified Medical Expenses
An individual generally is considered
a Medicare Advantage MSA because of
the death of the account holder. See
Generally, qualified medical expenses for
disabled if he or she is unable to engage
Death of Account Holder on page 2.
Archer MSA purposes are unreimbursed
in any substantial gainful activity due to a
You (or your spouse, if filing jointly)
medical expenses that could otherwise be
physical or mental impairment which can
were a policyholder who received
deducted on Schedule A (Form 1040).
be expected to result in death or to
payments under an LTC insurance
See the Instructions for Schedule A and
continue indefinitely.
contract or received any accelerated
Pub. 502, Medical and Dental Expenses.
Oct 25, 2011
Cat. No. 24188L

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