Instructions For Form 8889 - 2016 (Page 3 of 6) in pdf

Any excess contributions made by an

Line 2

contribution amount is taken into

employer (see

Excess Employer

account for each month you are an

Include on line 2 only those amounts

Contributions, later).

eligible individual.

you, or others on your behalf,

Figuring Your HSA Deduction

contributed to your HSA in 2016. Also,

Note. If you are married and had family

include those contributions made from

The maximum amount that can be

coverage at any time during the year,

January 1, 2017, through April 18, 2017,

contributed to your HSA depends on the

the additional contribution amount is

that were for 2016. Do not include

type of HDHP coverage you have. If you

figured on line 7 and is not included on

employer contributions (see line 9) or

have self-only coverage, your maximum

line 3.

amounts rolled over from another HSA

contribution is $3,350. If you have family

or Archer MSA. See Rollovers, earlier.

See Pub. 969 for more information.

coverage, your maximum contribution is

Also, do not include any qualified HSA

$6,750.

If you must complete the

Line 3

funding distributions (see line 10).

Limitation Chart and

Worksheet,

Contributions to an employee's account

TIP

Note. If you are age 55 or older at the

and your eligibility and coverage

through a cafeteria plan are treated as

end of your tax year, you can make an

did not change from one month to the

employer contributions and are not

additional contribution of $1,000.

next, enter the same number you

included on line 2.

entered for the previous month.

Your maximum contribution is

Line 3

reduced by any employer contributions

Line 6

When figuring the amount to enter on

to your HSA, any contributions made to

line 3, apply the following rules.

Spouses who have separate HSAs and

your Archer MSA, and any qualified

had family coverage under an HDHP at

HSA funding distributions.

1. Use the family coverage amount

any time during 2016, use the following

if you or your spouse had an HDHP with

You can make deductible

rules to figure the amount on line 6.

family coverage. Disregard any plan

contributions to your HSA even if your

If you are treated as having family

with self-only coverage.

employer made contributions. However,

coverage for each month, divide the

2. If the last-month rule (see

if you (or someone on your behalf)

amount on line 5 equally between you

Last-month

rule, earlier) applies, you

made contributions in addition to any

and your spouse, unless you both agree

are considered an eligible individual for

employer contributions and qualified

on a different allocation (such as

the entire year. You are treated as

HSA funding distributions, you may

allocating nothing to one spouse). Enter

having the same HDHP coverage for

have to pay an additional tax. See

your allocable share on line 6.

the entire year as you had on the first

Excess Contributions You

Make, later.

Example. In 2016, you are an

day of the last month of your tax year.

eligible individual and have self-only

You cannot deduct any contributions

3. If you were, or were considered,

HDHP coverage. In March you marry

for any month in which you were

an eligible individual for the entire year

and as of April 1 you have family HDHP

enrolled in Medicare. Also, you cannot

and you did not change your type of

coverage. Neither you nor your spouse

deduct contributions if you can be

coverage, enter $3,350 for a self-only

qualify for the additional contribution

claimed as a dependent on someone

HDHP or $6,750 for a family HDHP on

amount. Your spouse has a separate

else's 2016 tax return.

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

HSA and is an eligible individual from

How To Complete Part I

4. If you were, or were considered,

April 1 to December 31, 2016. Because

an eligible individual for the entire year

you and your spouse are considered to

Complete lines 1 through 13 as

and you changed your type of coverage

have family coverage on December 1,

instructed on the form. However, if you,

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

your contribution limit is $6,750 (the

and your spouse if filing jointly, are both

in this list) the greater of:

eligible individuals and either of you

family coverage maximum). You and

your spouse can divide this amount in

have an HDHP with family coverage,

a. The limitation shown on the last

any allocation to which you agree (such

you both are treated as having only the

line of the

Line 3 Limitation Chart and

as allocating nothing to one spouse).

family coverage plan. Disregard any

Worksheet, later or

If you are not treated as having family

plans with self-only coverage.

b. The maximum amount that can

coverage for each month, use the

be contributed based on the type of

Complete a separate Form 8889 for

following steps to determine the amount

HDHP coverage you had on the first day

each spouse. Combine the amounts on

to enter on line 6.

of the last month of your tax year.

line 13 of both Forms 8889 and enter

Step 1. Refigure the contribution

this amount on Form 1040, line 25; or

If you had family coverage on

limit that would have been entered on

Form 1040NR, line 25. Be sure to attach

the first day of the last month,

TIP

line 5 if you had entered on line 3 the

both Forms 8889 to your paper tax

you do not need to use the

total of the worksheet amounts only for

return.

worksheet; enter $6,750 on line 3.

the months you were treated as having

Line 1

5. If you were not an eligible

family coverage. When refiguring line 5,

individual on the first day of the last

use the same amount you previously

If you were covered, or considered

month of your tax year, use the

Line 3

entered on line 4.

covered, by a self-only HDHP and a

Limitation Chart and

Worksheet, later, to

family HDHP at different times during

Step 2. Divide the refigured

the year, check the box for the plan that

determine the amount to enter on line 3.

contribution limit from Step 1 equally

was in effect for a longer period. If you

(See (6) in this list.)

between you and your spouse, unless

were covered by both a self-only HDHP

6. If, at the end of 2016, you were

you both agree on a different allocation

and a family HDHP at the same time,

age 55 or older and unmarried or

(such as allocating nothing to one

you are treated as having family

married with self-only HDHP coverage

spouse).

coverage during that period. If, on the

for the entire year, you can increase the

first day of the last month of your tax

Step 3. Subtract the part of the

amount determined in (3) or (4) by

year, December 1 for most taxpayers,

contribution limit allocated to your

$1,000 (the additional contribution

you had family coverage, check the

amount). For (5), the additional

“family” box.

Form 8889 (2016)

-3-

Instructions For Form 8889 - 2016 Page 3

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