Instructions For Form 8889 (2015)


Department of the Treasury
Internal Revenue Service
Instructions for Form 8889
Health Savings Accounts (HSAs)
covered under a high deductible health
instructions for information on medical
Section references are to the Internal Revenue
Code unless otherwise noted.
plan (HDHP) and have no other health
expenses of dependents not claimed on
coverage except permitted coverage. If
your return.) You can receive
Future Developments
you are an eligible individual, anyone
distributions from an HSA even if you
can contribute to your HSA. However,
are not currently eligible to have
For the latest information about
you cannot be enrolled in Medicare or
contributions made to the HSA.
developments related to Form 8889 and
be claimed as a dependent on another
However, any part of a distribution not
its instructions, such as legislation
person's tax return. You must be, or be
used to pay qualified medical expenses
enacted after they were published, go to
considered, an eligible individual on the
is includible in gross income and is
first day of a month to take an HSA
subject to an additional 20% tax unless
deduction for that month (see
an exception applies.
General Instructions
rule, next).
Qualified Medical Expenses
Purpose of Form
Last-month rule. If you are an eligible
individual on the first day of the last
Generally, qualified medical expenses
Use Form 8889 to:
month of your tax year (December 1 for
for HSA purposes are unreimbursed
most taxpayers), you are considered to
Report health savings account (HSA)
medical expenses that could otherwise
be an eligible individual for the entire
contributions (including those made on
be deducted on Schedule A (Form
your behalf and employer contributions),
1040). See the Instructions for
Figure your HSA deduction,
Schedule A and Pub. 502, Medical and
Testing period. You must remain
Report distributions from HSAs, and
Dental Expenses. Expenses incurred
an eligible individual during the testing
before you establish your HSA are not
Figure amounts you must include in
period. The testing period begins with
qualified medical expenses. If, under
income and additional tax you may owe
the last month of your tax year and ends
the last-month rule, you are considered
if you fail to be an eligible individual.
on the last day of the 12th month
to be an eligible individual for the entire
following that month (for example,
Additional information. See Pub.
year for determining the contribution
December 1, 2015 – December 31,
969, Health Savings Accounts and
amount, only those expenses incurred
2016). If you fail to remain an eligible
Other Tax-Favored Health Plans, for
after you actually establish your HSA
individual during this period, other than
more details on HSAs.
are qualified medical expenses.
because of death or becoming disabled,
Who Must File
you will have to include in income the
Note. Only prescribed medicines or
total contributions made that would not
You must file Form 8889 if any of the
drugs (including over-the-counter
have been made except for the
following applies.
medicines and drugs that are
last-month rule. You include this amount
You (or someone on your behalf,
prescribed) and insulin (even if
in income in the year in which you fail to
including your employer) made
purchased without a prescription) for the
be an eligible individual. This amount is
contributions for 2015 to your HSA.
account beneficiary, the account
also subject to a 10% additional tax.
beneficiary's spouse or dependent(s),
You received HSA distributions in
are qualified medical expenses.
You must include certain amounts in
Account Beneficiary
You cannot treat insurance premiums
income because you failed to be an
as qualified medical expenses unless
eligible individual during the testing
The account beneficiary is the individual
the premiums are for:
on whose behalf the HSA was
1. Long-term care (LTC) insurance,
You acquired an interest in an HSA
2. Health care continuation
because of the death of the account
beneficiary. See
Death of Account
coverage (such as coverage under
Beneficiary, later.
Generally, an HSA is a health savings
3. Health care coverage while
account set up exclusively for paying
If you (or your spouse, if filing
receiving unemployment compensation
the qualified medical expenses of the
jointly) received HSA
under federal or state law, or
account beneficiary or the account
distributions in 2015, you must
beneficiary's spouse or dependents.
4. Medicare and other health care
file Form 8889 with Form 1040 even if
you have no taxable income or any
coverage if you were 65 or older (other
other reason for filing Form 1040.
Distributions From an HSA
than premiums for a Medicare
supplemental policy, such as Medigap).
Distributions from an HSA used
exclusively to pay qualified medical
Coverage under (2) and (3) can
expenses of the account beneficiary,
be for your spouse or a
Eligible Individual
spouse, or dependents are excludable
dependent meeting the
To be eligible to have contributions
from gross income. (See the
Line 15
requirement. For (4), if you, the account
made to your HSA, you must be
Oct 06, 2015
Cat. No. 37971Y


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