1099-SA ja 5498-SA
Ohjeet muodoille 1099-SA ja 5498-SA, HSA, Archer MSA tai Medicare Advantage MSA, ja HSA, Archer MSA tai Medicare Advantage MSA Tietoa
2023
Liittyvät lomakkeet
Department of the Treasury
Internal Revenue Service
2023
Instructions for Forms
1099-SA and 5498-SA
Distributions From an HSA, Archer MSA, or Medicare Advantage MSA, and HSA,
Archer MSA, or Medicare Advantage MSA Information
Section references are to the Internal Revenue Code
unless otherwise noted.
Advantage MSA (MA MSA). The distribution may have
been paid directly to a medical service provider or to the
account holder. A separate return must be filed for each
plan type.
Future Developments
For the latest information about developments related to
Forms 1099-SA and 5498-SA and their instructions, such
as legislation enacted after they were published, go to
Transfers
Do not report a trustee-to-trustee transfer from one Archer
MSA or MA MSA to another Archer MSA or MA MSA,
from an Archer MSA to an HSA, or from one HSA to
another HSA. For reporting purposes, contributions and
rollovers do not include transfers.
Reminders
In addition to these specific instructions, you should also
use the 2023 General Instructions for Certain Information
Returns. Those general instructions include information
about the following topics.
HSA Mistaken Distributions
If amounts were distributed during the year from an HSA
because of a mistake of fact due to reasonable cause, the
account beneficiary may repay the mistaken distribution
no later than the due date of the tax return (not counting
extensions) following the first year the account beneficiary
knew or should have known the distribution was a
mistake. For example, the account beneficiary
Who must file.
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When and where to file.
Electronic reporting.
Corrected and void returns.
Statements to recipients.
Taxpayer identification numbers (TINs).
Backup withholding.
reasonably, but mistakenly, believed that an expense was
a qualified medical expense and was reimbursed for that
expense from the HSA. The account beneficiary then
repays the mistaken distribution to the HSA.
Penalties.
Other general topics.
You can get the general instructions from IRS.gov/
Under these circumstances, the mistaken distribution is
not included in gross income, is not subject to the
additional 20% tax, and the repayment is not subject to
the excise tax on excess contributions. Do not treat the
repayment as a contribution on Form 5498-SA, HSA,
Archer MSA, or Medicare Advantage MSA Information.
Continuous-use form and instructions. Form 1099-SA
and its instructions are continuous use. Both the form and
instructions will be updated as needed. For the most
As the trustee or custodian, you do not have to
Online fillable forms. Due to the very low volume of
paper Forms 1099-SA and 5498-SA received and
processed by the IRS each year, these forms have been
converted to an online fillable format. You may fill out the
Form5498SA, and send Copy B to the recipient. For filing
with the IRS, follow the applicable procedures if you are
required to file electronically. For Forms 1099-SA and
5498-SA only, if due to a low volume of recipients, you
are filing the form(s) on paper, you can send in the
black-and-white Copy(ies) A with a Form 1096 that you
also printed from the IRS website.
allow beneficiaries to return a mistaken
TIP
distribution to the HSA. However, if you do allow
the return of the mistaken distribution, you may rely on the
account beneficiary's statement that the distribution was
in fact a mistake. See Notice 2004-50, 2004-33 I.R.B.
196, Q/A-76, available at IRS.gov/irb/
2004-33_IRB#NOT-2004-50. Do not report the mistaken
distribution on Form 1099-SA. Correct any filed Form
1099-SA with the IRS and the account beneficiary as soon
as you become aware of the error. See Corrected Returns
on Paper Forms in the current General Instructions for
Certain Information Returns for more information.
Specific Instructions for Form
1099-SA
HSA Closure Under the USA PATRIOT Act
If an HSA is closed at any time by the HSA trustee or
custodian due to a failure of the participant to satisfy the
Customer Identification Program requirements described
in section 326 of the USA PATRIOT Act, the distribution
from the HSA must be reported.
File Form 1099-SA, Distributions From an HSA, Archer
MSA, or Medicare Advantage MSA, to report distributions
made from a health savings account (HSA), Archer
medical savings account (Archer MSA), or Medicare
Aug 04, 2022
Cat. No. 38470S
If a regular contribution is made to the HSA that is
closed, and a distribution is made to the participant, enter
the gross distribution in box 1. If no earnings are
the account holder's death. The FMV of the account as of
the date of death is required to be reported in box 4.
Follow the rules and coding above under Distribution in
year of death and Distribution after year of death.
distributed, enter zero in box 2. If earnings are distributed,
enter the amount of earnings in box 2. Enter code 2 in
box 3. See the instructions for boxes 1 through 3, later.
Statements to Recipients
If you are required to file Form 1099-SA, you must provide
a statement to the recipient. For more information about
the requirement to furnish a Form 1099-SA or acceptable
substitute statement to recipients, see part M in the
current General Instructions for Certain Information
Returns.
In addition, Form 5498-SA must be filed to report any
rollover (qualified HSA funding distributions
(trustee-to-trustee transfers from an IRA to an HSA under
section 408(d)(9))) contributions to the HSA subsequently
closed by the trustee or custodian. See the Specific
Truncating Recipient's TIN on Payee Statements
Death of Account Holder
Archer MSAs and MA MSAs. When the account holder
dies and the designated beneficiary is the surviving
spouse, the following apply.
Pursuant to Regulations section 301.6109-4, all filers of
this form may truncate a recipient’s TIN (social security
number (SSN), individual taxpayer identification number
(ITIN), adoption taxpayer identification number (ATIN), or
employer identification number (EIN)) on payee
The spouse becomes the account holder of the Archer
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MSA.
statements. Truncation is not allowed on any documents
the filer files with the IRS. A trustee's/payer's TIN may not
be truncated on any form. See part J in the current
General Instructions for Certain Information Returns.
An MA MSA is treated as an Archer MSA of the spouse
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for distribution purposes.
Distributions from these accounts are subject to the
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rules that apply to Archer MSAs.
Account Number
If the designated beneficiary is not the spouse or there
is no named beneficiary, the account ceases to be an
MSA as of the date of death and the fair market value
(FMV) on that date is reported.
The account number is required if you have multiple
accounts for a recipient for whom you are filing more than
one Form 1099-SA. Additionally, the IRS encourages you
to designate an account number for all Forms 1099-SA
that you file. See part L in the current General Instructions
for Certain Information Returns.
If there is more than one recipient, the FMV should be
allocated among them, as appropriate.
If the beneficiary is the estate, enter the estate's name
and TIN in place of the recipient's on the form.
Distribution in year of death. If you learn of the
account holder's death and make a distribution to the
beneficiary in the year of death, issue a Form 1099-SA
and enter in:
Box 1. Gross Distribution
Enter the total amount of the distribution. Include any
earnings separately reported in box 2. You are not
required to determine the taxable amount of a distribution.
Do not report a negative amount in box 1. Do not report
the withdrawal of excess employer contributions (and the
earnings on them) returned to an employer as a
Box 1, the gross distribution;
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Box 4, the FMV of the account on the date of death.
Distribution after year of death. If you learn of the
distribution from an employee's HSA. Do not report
excess MA MSA contributions returned to the Secretary of
Health and Human Services or his or her representative.
death of the account holder and make a distribution after
the year of death, issue a Form 1099-SA in the year you
learned of the death of the account holder. Enter in:
Box 2. Earnings on Excess Contributions
Box 1, the gross distribution;
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Enter the total earnings distributed with any excess HSA
or Archer MSA contributions returned by the due date of
the account holder's tax return. Include this amount in
box 1. Report earnings on other distributions only in box 1.
Box 3, one of the following codes (see Box 3.
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Distribution Code, later):
1—If the beneficiary is the spouse,
4—If the beneficiary is the estate, or
6—If the beneficiary is not the spouse or estate;
For HSAs and Archer MSAs, if you are reporting
earnings on a distribution of excess contributions,
use the method under Regulations section
TIP
Box 4, the FMV of the account on the date of death,
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reduced by any payments from the HSA made for the
decedent's qualified medical expenses, if paid within 1
year after death.
1.408-11 for calculating the net income attributable to IRA
contributions that are distributed as a returned
contribution. If the amount in box 2 includes earnings on
excess contributions, enter distribution code 2 in box 3.
HSAs. When the account holder dies, the following
applies.
If the designated beneficiary is the surviving spouse,
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Box 3. Distribution Code
Enter the appropriate distribution code from the following
list that shows the type of distribution.
the spouse becomes the account holder of the HSA.
If the designated beneficiary is not the surviving
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spouse, the account ceases to be an HSA on the date of
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Instructions for Forms 1099-SA and 5498-SA (2023)
Distribution Codes for Distributions From HSAs, Archer MSAs, and Medicare Advantage MSAs
Use this code for normal distributions to the account
holder and any direct payments to a medical service
1—Normal distributions
provider. Use this code if no other code applies. Also, see
Distribution after year of death, earlier.
Use this code for distributions of excess HSA or Archer
MSA contributions to the account holder.
2—Excess contributions
Use this code if you made distributions after the account
holder was disabled (see section 72(m)(7)).
3—Disability
Use this code for payments to a decedent's estate in the
year of death. Also use this code for payments to an
4—Death distribution other than code 6
estate after the year of death. Do not use with code 6. See
Death of Account Holder, earlier.
5—Prohibited transaction
See sections 220(e)(2) and 223(e)(2).
Use this code for payments to a decedent's nonspouse
beneficiary, other than an estate, after the year of death.
Do not use with code 4.
6—Death distribution after year of death to a nonspouse
beneficiary
Box 4. FMV on Date of Death
Total Distribution, No Contributions
Enter the FMV of the account on the date of death. See
Generally, if a total distribution was made from an HSA or
Archer MSA during the year and no contributions were
made for that year, you need not file Form 5498-SA nor
furnish a statement to the participant to reflect that the fair
market value (FMV) on December 31 was zero.
Death of Account Holder, earlier.
Box 5. Checkbox
Check the box to indicate if this distribution was from an
HSA, Archer MSA, or MA MSA.
Death of Account Holder
In the year an HSA, Archer MSA, or MA MSA owner dies,
you must generally file a Form 5498-SA and furnish a
statement for the decedent. If the designated beneficiary
is the surviving spouse, the following apply.
Specific Instructions for Form
5498-SA
File Form 5498-SA, HSA, Archer MSA, or Medicare
Advantage MSA Information, with the IRS on or before
May 31, 2024, for each person for whom you maintained a
health savings account (HSA), Archer medical savings
account (Archer MSA), or Medicare Advantage MSA (MA
MSA) during 2023. You are required to file if you are the
trustee or custodian of an HSA, Archer MSA, or MA MSA.
A separate form is required for each type of plan.
The spouse becomes the account holder of the HSA or
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Archer MSA.
An MA MSA is treated as an Archer MSA of the spouse
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for distribution purposes, but no new contributions may be
made to the account.
If the designated beneficiary is not the spouse or there
is no designated beneficiary, the account ceases to be an
HSA, Archer MSA, or MA MSA.
For HSA or Archer MSA contributions made between
January 1, 2024, and April 15, 2024, you should obtain
the participant's designation of the year for which the
contributions are made.
For repayment of a mistaken distribution amount, see
HSA Mistaken Distributions, earlier. Do not treat the
repayment as a contribution on Form 5498-SA.
Statements to Participants
If you are required to file Form 5498-SA, you must provide
a statement to the participant (generally Copy B) by May
31, 2024. You may, but you are not required to, provide
the participant with a statement of the December 31,
2023, FMV of the participant's account by January 31,
2024. For more information about statements to
participants, see part M in the 2023 General Instructions
for Certain Information Returns.
Rollovers
You must report the receipt of a rollover from one Archer
MSA to another Archer MSA, and receipt of a rollover
from an Archer MSA or an HSA to an HSA in box 4.
If you furnished a statement of the FMV of the account
to the participant by January 31, 2024, and no reportable
contributions, including rollovers, were made for 2023,
you need not furnish another statement (or Form
5498-SA) to the participant to report zero contributions.
However, you must file Form 5498-SA with the IRS by
May 31, 2024, to report the December 31, 2023, FMV of
the account.
Transfers
Do not report a trustee-to-trustee transfer from one Archer
MSA or MA MSA to another Archer MSA or MA MSA,
from an Archer MSA to an HSA, or from one HSA to
another HSA. For reporting purposes, contributions and
rollovers do not include these transfers. However, see
Box 2, later, for the reporting of a trustee-to-trustee
transfer from an IRA to an HSA.
Instructions for Forms 1099-SA and 5498-SA (2023)
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If you do not furnish another statement to the
participant because no reportable contributions
were made for the year, the statement of the FMV
Box 2. Total Contributions Made in 2023
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Enter the total HSA or Archer MSA contributions made in
2023. Include any contribution made in 2023 for 2022.
Also include qualified HSA funding distributions
CAUTION
of the account must contain a legend designating which
information is being furnished to the IRS.
(trustee-to-trustee transfers from an IRA to an HSA under
section 408(d)(9)) received by you during 2023. Any
excess employer contributions (and the earnings on them)
withdrawn by the employer pursuant to Notice 2008-59,
Q/A 24, available at IRS.gov/irb/
Truncating Participant's TIN on Payee
Statements
Pursuant to Regulations section 301.6109-4, all filers of
this form may truncate a participant's TIN (social security
number (SSN), individual taxpayer identification number
(ITIN), adoption taxpayer identification number (ATIN), or
employer identification number (EIN)) on payee
2008-29_IRB#NOT-2008-59, should not be reported as a
contribution. You may, but you are not required to, report
the total MA MSA contributions made in 2023 by the
Secretary of Health and Human Services or his or her
representative. Do not include amounts reported in box 4.
statements. Truncation is not allowed on any documents
the filer files with the IRS. A trustee's TIN may not be
truncated on any form. See part J in the 2023 General
Instructions for Certain Information Returns.
Box 3. Total HSA or Archer MSA Contributions
Made in 2024 for 2023
Enter the total HSA or Archer MSA contributions made in
2024 for 2023.
Account Number
The account number is required if you have multiple
accounts for a recipient for whom you are filing more than
one Form 5498-SA. Additionally, the IRS encourages you
to designate an account number for all Forms 5498-SA
that you file. See part L in the 2023 General Instructions
for Certain Information Returns.
Box 4. Rollover Contributions
Enter rollover contributions to the HSA or Archer MSA
received by you during 2023. These amounts are not to
be included in box 2.
Box 5. Fair Market Value of HSA, Archer MSA, or
MA MSA
Enter the FMV of the account on December 31, 2023.
Box 1. Employee or Self-Employed Person's
Archer MSA Contributions Made in 2023 and
2024 for 2023
Enter the employee's or self-employed person's regular
contributions to the Archer MSA made in 2023 and
through April 15, 2024, for 2023. Report gross
contributions, including any excess contributions, even if
the excess contributions were withdrawn. No HSA
information is to be reported in box 1.
Box 6. Checkbox
Check the box to indicate if this account is an HSA, Archer
MSA, or MA MSA.
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Instructions for Forms 1099-SA and 5498-SA (2023)