Table of Contents

• General Instructions
  • Purpose of Form
  • Who Must File
• Specific Instructions
  • Section A—Archer MSAs
  • Part I—Archer MSA Contributions and Deductions
    • Figuring Your Archer MSA Deduction
    • How To Complete Part I
    • Line 1
    • Line 2
    • Line 3
    • Line 4
    • Line 5
  • Part II—Archer MSA Distributions
    • Line 6a
    • Line 6b
    • Line 7
    • Lines 9a and 9b
  • Section B—Medicare Advantage MSA Distributions
    • Line 10
    • Line 11
    • Lines 13a and 13b
  • Section C—Long-Term Care (LTC) Insurance Contracts
    • Definitions
    • Line 15
    • Line 18
    • Line 19
    • Line 21
    • Line 22
    • Line 24
    • Multiple Payees
    • Example 1
    • Example 2