Instructions For Form 8889 - Health Savings Accounts (Hsas)

HSA can only receive one rollover

enrolled in Medicare. Also, you cannot

the entire year as you had on the first

contribution during a 1-year period. See

deduct contributions if you can be

day of the last month of your tax year.

Pub. 590-A, Contributions to Individual

claimed as a dependent on someone

3. If you were, or were considered,

Retirement Arrangements (IRAs), for

else's 2017 tax return.

an eligible individual for the entire year

more details and additional

and you did not change your type of

How To Complete Part I

requirements regarding rollovers.

coverage, enter $3,400 for a self-only

Complete lines 1 through 13 as

HDHP or $6,750 for a family HDHP on

Note. If you instruct the trustee of your

instructed on the form. However, if you,

line 3. (See (6) in this list.)

HSA to transfer funds directly to the

and your spouse if filing jointly, are both

4. If you were, or were considered,

trustee of another of your HSAs, the

eligible individuals and either of you has

an eligible individual for the entire year

transfer is not considered a rollover.

an HDHP with family coverage, you

and you changed your type of coverage

There is no limit on the number of these

both are treated as having only the

during the year, enter on line 3 (see (6)

transfers. Do not include the amount

family coverage plan. Disregard any

in this list) the greater of:

transferred in income, deduct it as a

plans with self-only coverage.

contribution, or include it as a

a. The limitation shown on the last

Complete a separate Form 8889 for

distribution on line 14a.

line of the

Line 3 Limitation Chart and

each spouse. Combine the amounts on

Worksheet

(in these instructions), or

Specific Instructions

line 13 of both Forms 8889 and enter

b. The maximum amount that can

this amount on Form 1040, line 25; or

be contributed based on the type of

Form 1040NR, line 25. Be sure to attach

Name and social security number

HDHP coverage you had on the first day

both Forms 8889 to your paper tax

(SSN). Enter your name(s) as shown

of the last month of your tax year.

return.

on your tax return and the SSN of the

If you had family coverage on

HSA account beneficiary. If married

Line 1

the first day of the last month,

filing jointly and both you and your

TIP

If you were covered, or considered

you do not need to use the

spouse have HSAs, complete a

covered, by a self-only HDHP and a

worksheet; enter $6,750 on line 3.

separate Form 8889 for each of you.

family HDHP at different times during

5. If you were not an eligible

the year, check the box for the plan that

Part I—HSA Contributions

individual on the first day of the last

was in effect for a longer period. If you

and Deductions

month of your tax year, use the

Line 3

were covered by both a self-only HDHP

Limitation Chart and

Worksheet, later, to

Use Part I to figure:

and a family HDHP at the same time,

determine the amount to enter on line 3.

Your HSA deduction,

you are treated as having family

(See (6) in this list.)

Any excess contributions you made

coverage during that period. If, on the

(or those made on your behalf), and

first day of the last month of your tax

6. If, at the end of 2017, you were

Any excess contributions made by an

year, December 1 for most taxpayers,

age 55 or older and unmarried or

employer (see

Excess Employer

you had family coverage, check the

married with self-only HDHP coverage

Contributions, later).

“family” box.

for the entire year, you can increase the

amount determined in (3) or (4) by

Figuring Your HSA Deduction

Line 2

$1,000 (the additional contribution

The maximum amount that can be

Include on line 2 only those amounts

amount). For (5), the additional

contributed to your HSA depends on the

you, or others on your behalf,

contribution amount is taken into

type of HDHP coverage you have. If you

contributed to your HSA in 2017. Also,

account for each month you are an

have self-only coverage, your maximum

include those contributions made from

eligible individual.

contribution is $3,400. If you have family

January 1, 2018, through April 17, 2018,

coverage, your maximum contribution is

that were for 2017. Do not include

Note. If you are married and had family

$6,750.

employer contributions (see line 9) or

coverage at any time during the year,

amounts rolled over from another HSA

the additional contribution amount is

Note. If you are age 55 or older at the

or Archer MSA. See Rollovers, earlier.

figured on line 7 and is not included on

end of your tax year, you can make an

Also, do not include any qualified HSA

line 3.

additional contribution of $1,000.

funding distributions (see line 10).

See Pub. 969 for more information.

Contributions to an employee's account

Your maximum contribution is

through a cafeteria plan are treated as

If you must complete the

Line 3

reduced by any employer contributions

employer contributions and are not

Limitation Chart and

Worksheet,

to your HSA, any contributions made to

TIP

included on line 2.

and your eligibility and coverage

your Archer MSA, and any qualified

did not change from one month to the

HSA funding distributions.

Line 3

next, enter the same number you

You can make deductible

When figuring the amount to enter on

entered for the previous month.

contributions to your HSA even if your

line 3, apply the following rules.

employer made contributions. However,

Line 6

1. Use the family coverage amount

if you (or someone on your behalf)

if you or your spouse had an HDHP with

Spouses who have separate HSAs and

made contributions in addition to any

family coverage. Disregard any plan

had family coverage under an HDHP at

employer contributions and qualified

with self-only coverage.

any time during 2017, use the following

HSA funding distributions, you may

rules to figure the amount on line 6.

2. If the last-month rule (see

have to pay an additional tax. See

If you are treated as having family

Last-month

rule, earlier) applies, you

Excess Contributions You

Make, later.

are considered an eligible individual for

coverage for each month, divide the

the entire year. You are treated as

amount on line 5 equally between you

You cannot deduct any contributions

having the same HDHP coverage for

and your spouse, unless you both agree

for any month in which you were

Form 8889 (2017)

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Instructions For Form 8889 - Health Savings Accounts (Hsas) - 2017 Page 3

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