Form 1099-Sa - Distributions From An Hsa, Archer Msa, Or Medicare Advantage Msa - 2018 Page 3
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5Instructions for Recipient
Nonspouse beneficiary. If you inherited the HSA, Archer MSA, or MA MSA
from someone who wasn't your spouse, you must report as income on your tax
Distributions from a health savings account (HSA), Archer medical savings
return the FMV of the account as of the date of death. Report the FMV on your
account (MSA), or Medicare Advantage (MA) MSA are reported to you on
tax return for the year the account owner died even if you received the
Form 1099-SA. File Form 8853 or Form 8889 with your Form 1040 to report a
distribution from the account in a later year. See the Instructions for Form 8853
distribution from these accounts even if the distribution isn't taxable. The payer
or the Instructions for Form 8889. Any earnings on the account after the date of
isn't required to compute the taxable amount of any distribution.
death (box 1 minus box 4 of Form 1099-SA) are taxable. Include the earnings on
An HSA or Archer MSA distribution isn't taxable if you used it to pay qualified medical
the “Other income” line of your tax return.
expenses of the account holder or eligible family member or you rolled it over. An HSA
Account number. May show an account or other unique number the payer
may be rolled over to another HSA; an Archer MSA may be rolled over to another Archer
assigned to distinguish your account.
MSA or an HSA. An MA MSA isn't taxable if you used it to pay qualified medical
Box 1. Shows the amount received this year. The amount may have been a
expenses of the account holder only. If you didn't use the distribution from an HSA,
direct payment to the medical service provider or distributed to you.
Archer MSA, or MA MSA to pay for qualified medical expenses, or in the case of an HSA
Box 2. Shows the earnings on any excess contributions you withdrew from an HSA
or Archer MSA, you didn't roll it over, you must include the distribution in your income
or Archer MSA by the due date of your income tax return. If you withdrew the
(see Form 8853 or Form 8889). Also, you may owe a penalty.
excess, plus any earnings, by the due date of your income tax return, you must
You may repay a mistaken distribution from an HSA no later than April 15
include the earnings in your income in the year you received the distribution even if
following the first year you knew or should have known the distribution was a
you used it to pay qualified medical expenses. This amount is included in box 1.
mistake, providing the trustee allows the repayment.
Include the earnings on the “Other income” line of your tax return. An excise tax of
For more information, see the Instructions for Form 8853 and the Instructions
6% for each tax year is imposed on you for excess individual and employer
for Form 8889. Also see Pub. 969.
contributions that remain in the account. See Form 5329, Additional Taxes on
Recipient's taxpayer identification number (TIN). For your protection, this form
Qualified Plans (Including IRAs) and Other Tax-Favored Accounts.
may show only the last four digits of your TIN (SSN, ITIN, ATIN, or EIN). However,
Box 3. These codes identify the distribution you received: 1—Normal
the issuer has reported your complete identification number to the IRS.
distribution; 2—Excess contributions; 3—Disability; 4—Death distribution other
Spouse beneficiary. If you inherited an Archer MSA or MA MSA because of the death of
than code 6; 5—Prohibited transaction; 6—Death distribution after year of death
your spouse, special rules apply. See the Instructions for Form 8853. If you inherited an
to a nonspouse beneficiary.
HSA because of the death of your spouse, see the Instructions for Form 8889.
Box 4. If the account holder died, shows the FMV of the account on the date of death.
Estate beneficiary. If the HSA, Archer MSA, or MA MSA account holder dies
Box 5. Shows the type of account that is reported on this Form 1099-SA.
and the estate is the beneficiary, the fair market value (FMV) of the account on
Future developments. For the latest information about developments related to
the date of death is includible in the account holder’s gross income. Report the
Form 1099-SA and its instructions, such as legislation enacted after they were
amount on the account holder’s final income tax return.
published, go to
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