General Instructions

Table of Contents

Future developments.   For the latest information about developments related to Form 8853 and its instructions, such as legislation enacted after they were published, go to www.irs.gov/form8853.

After December 31, 2007, contributions cannot be made to an Archer MSA for you, unless:

  • You were an active Archer MSA participant for any tax year ending before January 1, 2008, or

  • You became an active Archer MSA participant for a tax year ending after December 31, 2007, because of coverage under a high deductible health plan of an Archer MSA participating employer.

Purpose of Form

Use Form 8853 to:

  • Report Archer MSA contributions (including employer contributions),

  • Figure your Archer MSA deduction,

  • Report distributions from Archer MSAs or Medicare Advantage MSAs,

  • Report taxable payments from long-term care (LTC) insurance contracts, or

  • Report taxable accelerated death benefits from a life insurance policy.

Additional information.   See Pub. 969, Health Savings Accounts and Other Tax-Favored Health Plans, for more details on MSAs.

Who Must File

You must file Form 8853 if any of the following applies.

  • You (or your employer) made contributions for 2012 to your Archer MSA.

  • You are filing a joint return and your spouse (or his or her employer) made contributions for 2012 to your spouse's Archer MSA.

  • You (or your spouse, if filing jointly) acquired an interest in an Archer MSA or a Medicare Advantage MSA because of the death of the account holder. See Death of Account Holder, later.

  • You (or your spouse, if filing jointly) were a policyholder who received payments under an LTC insurance contract or received any accelerated death benefits from a life insurance policy on a per diem or other periodic basis in 2012. See the instructions for Section C, later.

  • You (or your spouse, if filing jointly) received Archer MSA or Medicare Advantage MSA distributions in 2012.

If you (or your spouse, if filing jointly) received Archer MSA or Medicare Advantage MSA distributions in 2012, you must file Form 8853 with a Form 1040 even if you have no taxable income or any other reason for filing Form 1040.

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