Instructions For Form 8889 - Health Savings Accounts (Hsas) - 2017 Page 4
ADVERTISEMENT
1
2
3
4
5
6
7on a different allocation (such as
self-only coverage is $2,550 ($3,400 × 9
coverage + $2,550 self-only coverage –
allocating nothing to one spouse). Enter
÷ 12). This amount is not divided
$1,265.63 spousal allocation) or (b) the
your allocable share on line 6.
between you and your spouse.
maximum amount that can be
contributed ($3,400 for self-only
Because you are covered under a
Example. In 2017, you are an
coverage). Your ex-spouse would show
self-only policy on December 1, you will
eligible individual and have self-only
$6,750 on line 6 (the greater of either (a)
show $3,400 on line 6 (the greater of
HDHP coverage. In March you marry
$6,328.13 ($1,687.50 family coverage
either (a) $2,971.87 ($1,687.50 family
and as of April 1 you have family HDHP
for the 3 months prior to the divorce +
coverage. Neither you nor your spouse
qualify for the additional contribution
Line 3 Limitation Chart and Worksheet
amount. Your spouse has a separate
HSA and is an eligible individual from
Before you begin: See the instructions for line 3, earlier.
April 1 to December 31, 2017. Because
Go through this chart for each month of 2017.
you and your spouse are considered to
(Keep for your records)
have family coverage on December 1,
your contribution limit is $6,750 (the
Start Here
family coverage maximum). You and
Were you enrolled in Medicare for the
your spouse can divide this amount in
Yes
month?
any allocation to which you agree (such
as allocating nothing to one spouse).
No
If you are not treated as having family
coverage for each month, use the
following steps to determine the amount
Were you an eligible individual (see
to enter on line 6.
Eligible Individual, earlier) on the rst
Enter -0- on the line
No
day of the month (see the line 3
below for the month.
Step 1. Refigure the contribution
instructions, earlier)?
limit that would have been entered on
line 5 if you had entered on line 3 the
Yes
total of the worksheet amounts only for
the months you were treated as having
family coverage. When refiguring line 5,
What type of coverage did your HDHP provide on the rst
use the same amount you previously
day of the month?
entered on line 4.
Step 2. Divide the refigured
contribution limit from Step 1 equally
Self-only coverage
Family coverage
between you and your spouse, unless
Enter $6,750 on the line below for the
Enter $3,400 on the line below for the
you both agree on a different allocation
month. If, at the end of 2017, you were
month. If you were age 55 or older at the
(such as allocating nothing to one
unmarried and age 55 or older, enter
end of 2017, enter $4,400 for the month.
$7,750 for the month.
spouse).
Step 3. Subtract the part of the
contribution limit allocated to your
spouse in Step 2 from the amount
Amount from
determined in Step 1.
chart above
Month in 2017
Step 4. Determine any other
January
contribution limits that apply for the tax
year and add that amount to the result in
February
Step 3. Enter the total on line 6.
March
Example. In 2017, you are an
eligible individual and have family
April
HDHP coverage. In March you divorce
May
and change your coverage as of April 1
to self-only. Neither you nor your
June
ex-spouse qualify for the additional
contribution amount. Your ex-spouse
July
continued to have family HDHP
August
coverage and was an eligible individual
for the entire year. The contribution limit
September
for the 3 months you both were
considered to have family coverage is
October
$1,687.50 ($6,750 × 3 ÷ 12). You and
November
your ex-spouse decide to divide the
family coverage contribution in the
December
following manner: 75% to your
Total for all months
ex-spouse and 25% to you. Your
contribution limit for 9 months of
Limitation. Divide the total by 12. Enter here and on line 3
-4-
Form 8889 (2017)
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Financial