Instructions for IRS Form 1099-SA, 5498-SA "Distributions From an Hsa, Archer Msa, or Medicare Advantage Msa, and Hsa, Archer Msa, or Medicare Advantage Msa Information"

This document contains official instructions for IRS Form 1099-SA, and IRS Form 5498-SA. Both forms are released and collected by the Internal Revenue Service (IRS), a subdivision of the U.S. Department of the Treasury. An up-to-date fillable IRS Form 1099-SA is available for download through this link. The latest available IRS Form 5498-SA can be downloaded through this link.

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2020
Department of the Treasury
Internal Revenue Service
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
an Archer MSA to an HSA, or from one HSA to another HSA. For
otherwise noted.
reporting purposes, contributions and rollovers do not include
transfers.
Future Developments
HSA mistaken distributions. If amounts were distributed during
For the latest information about developments related to Forms
the year from an HSA because of a mistake of fact due to
1099-SA and 5498-SA and their instructions, such as legislation
reasonable cause, the account beneficiary may repay the mistaken
enacted after they were published, go to
IRS.gov/Form1099SA
and
distribution no later than April 15 following the first year the account
IRS.gov/Form5498SA.
beneficiary knew or should have known the distribution was a
mistake. For example, the account beneficiary reasonably, but
What’s New
mistakenly, believed that an expense was a qualified medical
expense and was reimbursed for that expense from the HSA. The
Continuous-use form and instructions. Form 1099-SA and its
account beneficiary then repays the mistaken distribution to the
instructions, contained herein, have been converted from an annual
HSA.
revision to continuous use. Both the form and instructions will be
Under these circumstances, the mistaken distribution is not
updated as needed. For the most recent version, go to
IRS.gov/
included in gross income, is not subject to the additional 20% tax,
Form1099SA.
and the repayment is not subject to the excise tax on excess
Reminders
contributions. Do not treat the repayment as a contribution on Form
5498-SA, HSA, Archer MSA, or Medicare Advantage MSA
General instructions. In addition to these specific instructions, you
Information.
should also use the 2020 General Instructions for Certain
As the trustee or custodian, you do not have to allow
Information Returns. Those general instructions include information
beneficiaries to return a mistaken distribution to the HSA.
about the following topics.
TIP
However, if you do allow the return of the mistaken
Who must file.
distribution, you may rely on the account beneficiary's statement that
When and where to file.
the distribution was in fact a mistake. See Notice 2004-50, 2004-33
Electronic reporting.
I.R.B. 196, Q/A-76, available at IRS.gov/irb/2004-33_IRB/ar08.html.
Corrected and void returns.
Do not report the mistaken distribution on Form 1099-SA. Correct
Statements to recipients.
any filed Form 1099-SA with the IRS and the account beneficiary as
Taxpayer identification numbers (TINs).
soon as you become aware of the error. See Corrected Returns on
Backup withholding.
Paper Forms in the current General Instructions for Certain
Penalties.
Information Returns for more information.
Other general topics.
You can get the general instructions from
IRS.gov/
HSA Closure Under the USA PATRIOT Act
GeneralInstructions, IRS.gov/Form1099SA, and
IRS.gov/
Form5498SA.
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
Online fillable form. Due to the very low volume of paper Forms
Program requirements described in section 326 of the USA
1099-SA and 5498-SA received and processed by the IRS each
PATRIOT Act, the distribution from the HSA must be reported.
year, these forms have been converted to an online fillable format.
You may fill out the forms, found online at
IRS.gov/Form1099SA
and
If a regular contribution is made to the HSA that is closed, and a
IRS.gov/Form5498SA, and send Copy B to the recipient. For filing
distribution is made to the participant, enter the gross distribution in
with the IRS, follow the applicable procedures if you are required to
box 1. If no earnings are distributed, enter zero in box 2. If earnings
file electronically. For Forms 1099-SA and 5498-SA only, if due to
are distributed, enter the amount of earnings in box 2. Enter code 2
a low volume of recipients, you are filing the form(s) on paper, you
in box 3. See the instructions for boxes 1 through 3, later.
can send in the black-and-white Copy(ies) A with a Form 1096 that
you also printed from the IRS website.
In addition, Form 5498-SA must be filed to report any rollover
(qualified HSA funding distributions (trustee-to-trustee transfers from
Specific Instructions for Form
an IRA to an HSA under section 408(d)(9))) contributions to the HSA
subsequently closed by the trustee or custodian. See the
Specific
1099-SA
Instructions for Form
5498-SA, later.
File Form 1099-SA, Distributions From an HSA, Archer MSA, or
Death of Account Holder
Medicare Advantage MSA, to report distributions made from a
health savings account (HSA), Archer medical savings account
Archer MSAs and MA MSAs. When the account holder dies and
(Archer MSA), or Medicare Advantage MSA (MA MSA). The
the designated beneficiary is the surviving spouse, the following
distribution may have been paid directly to a medical service
apply.
provider or to the account holder. A separate return must be filed for
The spouse becomes the account holder of the Archer MSA.
each plan type.
An MA MSA is treated as an Archer MSA of the spouse for
distribution purposes.
Transfers. Do not report a trustee-to-trustee transfer from one
Distributions from these accounts are subject to the rules that
Archer MSA or MA MSA to another Archer MSA or MA MSA, from
apply to Archer MSAs.
Oct 22, 2019
Cat. No. 38470S
2020
Department of the Treasury
Internal Revenue Service
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
an Archer MSA to an HSA, or from one HSA to another HSA. For
otherwise noted.
reporting purposes, contributions and rollovers do not include
transfers.
Future Developments
HSA mistaken distributions. If amounts were distributed during
For the latest information about developments related to Forms
the year from an HSA because of a mistake of fact due to
1099-SA and 5498-SA and their instructions, such as legislation
reasonable cause, the account beneficiary may repay the mistaken
enacted after they were published, go to
IRS.gov/Form1099SA
and
distribution no later than April 15 following the first year the account
IRS.gov/Form5498SA.
beneficiary knew or should have known the distribution was a
mistake. For example, the account beneficiary reasonably, but
What’s New
mistakenly, believed that an expense was a qualified medical
expense and was reimbursed for that expense from the HSA. The
Continuous-use form and instructions. Form 1099-SA and its
account beneficiary then repays the mistaken distribution to the
instructions, contained herein, have been converted from an annual
HSA.
revision to continuous use. Both the form and instructions will be
Under these circumstances, the mistaken distribution is not
updated as needed. For the most recent version, go to
IRS.gov/
included in gross income, is not subject to the additional 20% tax,
Form1099SA.
and the repayment is not subject to the excise tax on excess
Reminders
contributions. Do not treat the repayment as a contribution on Form
5498-SA, HSA, Archer MSA, or Medicare Advantage MSA
General instructions. In addition to these specific instructions, you
Information.
should also use the 2020 General Instructions for Certain
As the trustee or custodian, you do not have to allow
Information Returns. Those general instructions include information
beneficiaries to return a mistaken distribution to the HSA.
about the following topics.
TIP
However, if you do allow the return of the mistaken
Who must file.
distribution, you may rely on the account beneficiary's statement that
When and where to file.
the distribution was in fact a mistake. See Notice 2004-50, 2004-33
Electronic reporting.
I.R.B. 196, Q/A-76, available at IRS.gov/irb/2004-33_IRB/ar08.html.
Corrected and void returns.
Do not report the mistaken distribution on Form 1099-SA. Correct
Statements to recipients.
any filed Form 1099-SA with the IRS and the account beneficiary as
Taxpayer identification numbers (TINs).
soon as you become aware of the error. See Corrected Returns on
Backup withholding.
Paper Forms in the current General Instructions for Certain
Penalties.
Information Returns for more information.
Other general topics.
You can get the general instructions from
IRS.gov/
HSA Closure Under the USA PATRIOT Act
GeneralInstructions, IRS.gov/Form1099SA, and
IRS.gov/
Form5498SA.
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
Online fillable form. Due to the very low volume of paper Forms
Program requirements described in section 326 of the USA
1099-SA and 5498-SA received and processed by the IRS each
PATRIOT Act, the distribution from the HSA must be reported.
year, these forms have been converted to an online fillable format.
You may fill out the forms, found online at
IRS.gov/Form1099SA
and
If a regular contribution is made to the HSA that is closed, and a
IRS.gov/Form5498SA, and send Copy B to the recipient. For filing
distribution is made to the participant, enter the gross distribution in
with the IRS, follow the applicable procedures if you are required to
box 1. If no earnings are distributed, enter zero in box 2. If earnings
file electronically. For Forms 1099-SA and 5498-SA only, if due to
are distributed, enter the amount of earnings in box 2. Enter code 2
a low volume of recipients, you are filing the form(s) on paper, you
in box 3. See the instructions for boxes 1 through 3, later.
can send in the black-and-white Copy(ies) A with a Form 1096 that
you also printed from the IRS website.
In addition, Form 5498-SA must be filed to report any rollover
(qualified HSA funding distributions (trustee-to-trustee transfers from
Specific Instructions for Form
an IRA to an HSA under section 408(d)(9))) contributions to the HSA
subsequently closed by the trustee or custodian. See the
Specific
1099-SA
Instructions for Form
5498-SA, later.
File Form 1099-SA, Distributions From an HSA, Archer MSA, or
Death of Account Holder
Medicare Advantage MSA, to report distributions made from a
health savings account (HSA), Archer medical savings account
Archer MSAs and MA MSAs. When the account holder dies and
(Archer MSA), or Medicare Advantage MSA (MA MSA). The
the designated beneficiary is the surviving spouse, the following
distribution may have been paid directly to a medical service
apply.
provider or to the account holder. A separate return must be filed for
The spouse becomes the account holder of the Archer MSA.
each plan type.
An MA MSA is treated as an Archer MSA of the spouse for
distribution purposes.
Transfers. Do not report a trustee-to-trustee transfer from one
Distributions from these accounts are subject to the rules that
Archer MSA or MA MSA to another Archer MSA or MA MSA, from
apply to Archer MSAs.
Oct 22, 2019
Cat. No. 38470S
Box 2. Earnings on Excess Contributions
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
Enter the total earnings distributed with any excess HSA or Archer
of death and the fair market value (FMV) on that date is reported.
MSA contributions returned by the due date of the account holder's
If there is more than one recipient, the FMV should be allocated
tax return. Include this amount in box 1. Report earnings on other
among them, as appropriate.
distributions only in box 1.
If the beneficiary is the estate, enter the estate's name and TIN in
For HSAs and Archer MSAs, if you are reporting earnings on
place of the recipient's on the form.
a distribution of excess contributions, use the method under
TIP
Distribution in year of death. If you learn of the account
Regulations section 1.408-11 for calculating the net income
holder's death and make a distribution to the beneficiary in the year
attributable to IRA contributions that are distributed as a returned
of death, issue a Form 1099-SA and enter in:
contribution. If the amount in box 2 includes earnings on excess
Box 1, the gross distribution;
contributions, enter distribution code 2 in box 3.
Box 3, code 4 (see
Box 3. Distribution
Code, later); and
Box 4, the FMV of the account on the date of death.
Box 3. Distribution Code
Distribution after year of death. If you learn of the death of the
account holder and make a distribution after the year of death, issue
Enter the appropriate distribution code from the following list that
a Form 1099-SA in the year you learned of the death of the account
shows the type of distribution.
holder. Enter in:
Box 1, the gross distribution;
1—Normal distributions
Use this code for normal distributions to
Box 3, one of the following codes (see
Box 3. Distribution
Code,
the account holder and any direct
later):
payments to a medical service
1—If the beneficiary is the spouse,
provider. Use this code if no other code
4—If the beneficiary is the estate, or
applies. Also, see
Distribution after
6—If the beneficiary is not the spouse or estate;
year of
death, earlier.
Box 4, the FMV of the account on the date of death, reduced by
2—Excess contributions
Use this code for distributions of
any payments from the HSA made for the decedent's qualified
excess HSA or Archer MSA
medical expenses, if paid within 1 year after death.
contributions to the account holder.
HSAs. When the account holder dies, the following applies.
3—Disability
Use this code if you made distributions
If the designated beneficiary is the surviving spouse, the spouse
after the account holder was disabled
becomes the account holder of the HSA.
(see section 72(m)(7)).
If the designated beneficiary is not the surviving spouse, the
account ceases to be an HSA on the date of the account holder's
4—Death distribution other
Use this code for payments to a
death. The FMV of the account as of the date of death is required to
than code 6
decedent's estate in the year of death.
be reported in box 4. Follow the rules and coding above under
Also use this code for payments to an
Distribution in year of death and Distribution after year of death.
estate after the year of death. Do not
use with code 6. See
Death of Account
Statements to Recipients
Holder, earlier.
If you are required to file Form 1099-SA, you must provide a
5—Prohibited transaction
See sections 220(e)(2) and 223(e)(2).
statement to the recipient. For more information about the
requirement to furnish a Form 1099-SA or acceptable substitute
6—Death distribution after
Use this code for payments to a
statement to recipients, see part M in the current General
year of death to a
decedent's nonspouse beneficiary,
Instructions for Certain Information Returns.
nonspouse beneficiary
other than an estate, after the year of
death. Do not use with code 4.
Truncating Recipient's TIN on Payee Statements
Pursuant to Regulations section 301.6109-4, all filers of this form
may truncate a recipient’s TIN (social security number (SSN),
Box 4. FMV on Date of Death
individual taxpayer identification number (ITIN), adoption taxpayer
identification number (ATIN), or employer identification number
Enter the FMV of the account on the date of death. See
Death of
(EIN)) on payee statements. Truncation is not allowed on any
Account
Holder, earlier.
documents the filer files with the IRS. A trustee's/payer's TIN may
Box 5. Checkbox
not be truncated on any form. See part J in the current General
Instructions for Certain Information Returns.
Check the box to indicate if this distribution was from an HSA,
Archer MSA, or MA MSA.
Account Number
The account number is required if you have multiple accounts for a
Specific Instructions for Form
recipient for whom you are filing more than one Form 1099-SA.
5498-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
File Form 5498-SA, HSA, Archer MSA, or Medicare Advantage MSA
General Instructions for Certain Information Returns.
Information, with the IRS on or before June 1, 2021, for each person
Box 1. Gross Distribution
for whom you maintained a health savings account (HSA), Archer
medical savings account (Archer MSA), or Medicare Advantage
Enter the total amount of the distribution. Include any earnings
MSA (MA MSA) during 2020. You are required to file if you are the
separately reported in box 2. You are not required to determine the
trustee or custodian of an HSA, Archer MSA, or MA MSA. A
taxable amount of a distribution. Do not report a negative amount in
separate form is required for each type of plan.
box 1. Do not report the withdrawal of excess employer contributions
(and the earnings on them) returned to an employer as a distribution
For HSA or Archer MSA contributions made between January 1,
from an employee's HSA. Do not report excess MA MSA
2021, and April 15, 2021, you should obtain the participant's
contributions returned to the Secretary of Health and Human
designation of the year for which the contributions are made.
Services or his or her representative.
For repayment of a mistaken distribution amount, see
HSA
mistaken
distributions, earlier. Do not treat the repayment as a
contribution on Form 5498-SA.
-2-
Instructions for Forms 1099-SA and 5498-SA (2020)
Rollovers
individual taxpayer identification number (ITIN), adoption taxpayer
identification number (ATIN), or employer identification number
You must report the receipt of a rollover from one Archer MSA to
(EIN)) on payee statements. Truncation is not allowed on any
another Archer MSA, and receipt of a rollover from an Archer MSA
documents the filer files with the IRS. A trustee's TIN may not be
or an HSA to an HSA in box 4.
truncated on any form. See part J in the 2020 General Instructions
for Certain Information Returns.
Transfers
Account Number
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
The account number is required if you have multiple accounts for a
to an HSA, or from one HSA to another HSA. For reporting
recipient for whom you are filing more than one Form 5498-SA.
purposes, contributions and rollovers do not include these transfers.
Additionally, the IRS encourages you to designate an account
However, see
Box
2, later, for the reporting of a trustee-to-trustee
number for all Forms 5498-SA that you file. See part L in the 2020
transfer from an IRA to an HSA.
General Instructions for Certain Information Returns.
Total Distribution, No Contributions
Box 1. Employee or Self-Employed Person's
Generally, if a total distribution was made from an HSA or Archer
Archer MSA Contributions Made in 2020 and
MSA during the year and no contributions were made for that year,
2021 for 2020
you need not file Form 5498-SA nor furnish a statement to the
participant to reflect that the fair market value (FMV) on December
Enter the employee's or self-employed person's regular
31 was zero.
contributions to the Archer MSA made in 2020 and through April 15,
2021, for 2020. Report gross contributions, including any excess
Death of Account Holder
contributions, even if the excess contributions were withdrawn. No
HSA information is to be reported in box 1.
In the year an HSA, Archer MSA, or MA MSA owner dies, generally
you must file a Form 5498-SA and furnish a statement for the
Box 2. Total Contributions Made in 2020
decedent. If the designated beneficiary is the surviving spouse, the
following apply.
Enter the total HSA or Archer MSA contributions made in 2020.
The spouse becomes the account holder of the HSA or Archer
Include any contribution made in 2020 for 2019. Also include
MSA.
qualified HSA funding distributions (trustee-to-trustee transfers from
An MA MSA is treated as an Archer MSA of the spouse for
an IRA to an HSA under section 408(d)(9)) received by you during
distribution purposes, but no new contributions may be made to the
2020. Any excess employer contributions (and the earnings on
account.
them) withdrawn by the employer pursuant to Notice 2008-59, Q/A
24, available at IRS.gov/irb/2008-29_IRB/ar11.html, should not be
If the designated beneficiary is not the spouse or there is no
reported as a contribution. You may, but you are not required to,
designated beneficiary, the account ceases to be an HSA, Archer
report the total MA MSA contributions made in 2020 by the
MSA, or MA MSA.
Secretary of Health and Human Services or his or her
Statements to Participants
representative. Do not include amounts reported in box 4.
If you are required to file Form 5498-SA, you must provide a
Box 3. Total HSA or Archer MSA Contributions
statement to the participant (generally Copy B) by June 1, 2021. You
Made in 2021 for 2020
may, but you are not required to, provide the participant with a
statement of the December 31, 2020, FMV of the participant's
Enter the total HSA or Archer MSA contributions made in 2021 for
account by February 1, 2021. For more information about
2020.
statements to participants, see part M in the 2020 General
Box 4. Rollover Contributions
Instructions for Certain Information Returns.
If you furnished a statement of the FMV of the account to the
Enter rollover contributions to the HSA or Archer MSA received by
participant by February 1, 2021, and no reportable contributions,
you during 2020. These amounts are not to be included in box 2.
including rollovers, were made for 2020, you need not furnish
another statement (or Form 5498-SA) to the participant to report
Box 5. Fair Market Value of HSA, Archer MSA, or
zero contributions. However, you must file Form 5498-SA with the
MA MSA
IRS by June 1, 2021, to report the December 31, 2020, FMV of the
Enter the FMV of the account on December 31, 2020.
account.
If you do not furnish another statement to the participant
Box 6. Checkbox
because no reportable contributions were made for the year,
!
Check the box to indicate if this account is an HSA, Archer MSA, or
the statement of the FMV of the account must contain a
CAUTION
MA MSA.
legend designating which information is being furnished to the IRS.
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),
Instructions for Forms 1099-SA and 5498-SA (2020)
-3-
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