Instructions For Form 8889 (2015) printable pdf download

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

Last-month

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

year.

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

(See

Part

III.)

are qualified medical expenses.

2015.

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:

period.

on whose behalf the HSA was

1. Long-term care (LTC) insurance,

established.

You acquired an interest in an HSA

2. Health care continuation

because of the death of the account

HSA

beneficiary. See

Death of Account

coverage (such as coverage under

Beneficiary, later.

COBRA),

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

CAUTION

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

Definitions

exclusively to pay qualified medical

Coverage under (2) and (3) can

expenses of the account beneficiary,

be for your spouse or a

Eligible Individual

TIP

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

Instructions For Form 8889 (2015)

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