Instructions For Form 8853 - 2016


Department of the Treasury
Internal Revenue Service
Instructions for Form 8853
Archer MSAs and Long-Term Care Insurance Contracts
Section references are to the Internal Revenue Code
accelerated death benefits from a life insurance
Instructions for Schedule A (Form 1040),
unless otherwise noted.
policy on a per diem or other periodic basis in
Itemized Deductions and Pub. 502, Medical
2016. See the instructions for Section C, later.
and Dental Expenses. Qualified medical
Future Developments
You (or your spouse, if filing jointly) received
expenses are those incurred by the account
Archer MSA or Medicare Advantage MSA
holder or the account holder's spouse or
For the latest information about developments
distributions in 2016.
dependent(s). Only prescribed medicines or
related to Form 8853 and its instructions, such
drugs (including over-the-counter medicines
If you (or your spouse, if filing jointly)
as legislation enacted after they were
and drugs that are prescribed) and insulin (even
received Archer MSA or Medicare
published, go to
if purchased without a prescription) for the
Advantage MSA distributions in
General Instructions
account holder or the account holder's spouse
2016, you must file Form 8853 with Form 1040
or dependent(s), are qualified medical
even if you have no taxable income or any other
expenses. See the instructions for line 7, later.
reason for filing Form 1040.
After December 31, 2007,
You can't treat insurance premiums as qualified
contributions can't be made to an
medical expenses unless the premiums are for:
Archer MSA for you, unless:
Specific Instructions
Long-term care (LTC) insurance,
You were an active Archer MSA participant
Health care continuation coverage, or
for any tax year ending before January 1, 2008,
Name and social security number (SSN).
Health care coverage while receiving
Enter your name(s) and SSN as shown on your
unemployment compensation under federal or
You became an active Archer MSA
tax return. If filing jointly and both you and your
state law.
participant for a tax year ending after December
spouse each have an Archer MSA or each have
31, 2007, because of coverage under a high
a Medicare Advantage MSA, enter the SSN
High Deductible Health Plan
deductible health plan of an Archer MSA
shown first on your tax return.
An HDHP is a health plan that meets the
participating employer.
Section A—Archer MSAs
following requirements.
Purpose of Form
Eligible Individual
Use Form 8853 to:
To be eligible for an Archer MSA, you (or your
Minimum annual deductible
Report Archer MSA contributions (including
spouse) must be an employee of a small
employer contributions),
Maximum annual deductible
employer or be self-employed. You (or your
Figure your Archer MSA deduction,
spouse) must be covered under a high
Maximum annual
Report distributions from Archer MSAs or
out-of-pocket expenses
deductible health plan (HDHP) and have no
(other than for premiums)
Medicare Advantage MSAs,
other health coverage except permitted
Report taxable payments from long-term
coverage. You must not be enrolled in Medicare
care (LTC) insurance contracts, or
and can't be claimed as a dependent on
Other Health Coverage
Report taxable accelerated death benefits
someone else's 2016 tax return. You must be
from a life insurance policy.
If you have an Archer MSA, you (and your
an eligible individual on the first day of a month
to take an Archer MSA deduction for that
spouse, if you have family coverage) can't have
Additional information. See Pub. 969, Health
any health coverage other than an HDHP. But
Savings Accounts and Other Tax-Favored
your spouse can have health coverage other
Health Plans, for more details on MSAs.
Small Employer
than an HDHP if you aren't covered by that
Who Must File
A small employer is generally an employer who
had an average of 50 or fewer employees
Exceptions. You can have additional
You must file Form 8853 if any of the following
during either of the last 2 calendar years. See
insurance that provides benefits only for:
Pub. 969 for details.
Liabilities under workers' compensation
You (or your employer) made contributions
Archer MSA
laws, tort liabilities, or liabilities arising from the
for 2016 to your Archer MSA.
ownership or use of property,
You are filing a joint return and your spouse
Generally, an Archer MSA is a medical savings
A specific disease or illness, or
(or his or her employer) made contributions for
account set up exclusively for paying the
A fixed amount per day (or other period) of
2016 to your spouse's Archer MSA.
qualified medical expenses of the account
You (or your spouse, if filing jointly) acquired
an interest in an Archer MSA or a Medicare
You can also have coverage (either through
Qualified Medical Expenses
Advantage MSA because of the death of the
insurance or otherwise) for accidents, disability,
account holder. See
Death of Account
dental care, vision care, or long-term care.
Generally, qualified medical expenses for
Archer MSA purposes are unreimbursed
You (or your spouse, if filing jointly) were a
medical expenses that could otherwise be
policyholder who received payments under an
An individual generally is considered disabled if
deducted on Schedule A (Form 1040). See the
LTC insurance contract or received any
he or she is unable to engage in any substantial
Sep 08, 2016
Cat. No. 24188L


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