Specific Instructions

Name and social security number (SSN).   Enter your name(s) as shown on your tax return and the SSN of the HSA account beneficiary. If married filing jointly and both you and your spouse have HSAs, complete a separate Form 8889 for each of you.

Part I—HSA Contributions and Deductions

Use Part I to figure:

  • Your HSA deduction,

  • Any excess contributions you made (or those made on your behalf), and

  • Any excess contributions made by an employer (see Excess Employer Contributions, later).

Figuring Your HSA Deduction

The maximum amount that can be contributed to your HSA depends on the type of HDHP coverage you have. If you have self-only coverage, your maximum contribution is $3,300. If you have family coverage, your maximum contribution is $6,550.

Note.

If you are age 55 or older at the end of your tax year, you can make an additional contribution of $1,000.

Your maximum contribution is reduced by any employer contributions to your HSA, any contributions made to your Archer MSA, and any qualified HSA funding distributions.

You can make deductible contributions to your HSA even if your employer made contributions. However, if you (or someone on your behalf) made contributions in addition to any employer contributions and qualified HSA funding distributions, you may have to pay an additional tax. See Excess Contributions You Make, later.

You cannot deduct any contributions for any month in which you were enrolled in Medicare. Also, you cannot deduct contributions if you can be claimed as a dependent on someone else's 2014 tax return.

How To Complete Part I

Complete lines 1 through 13 as instructed on the form. However, if you, and your spouse if filing jointly, are both eligible individuals and either of you have an HDHP with family coverage, you both are treated as having only the family coverage plan. Disregard any plans with self-only coverage.

Complete a separate Form 8889 for each spouse. Combine the amounts on line 13 of both Forms 8889 and enter this amount on Form 1040, line 25; or Form 1040NR, line 25. Be sure to attach both Forms 8889 to your paper tax return.

Line 1

If you were covered, or considered covered, by a self-only HDHP and a family HDHP at different times during the year, check the box for the plan that was in effect for a longer period. If you were covered by both a self-only HDHP and a family HDHP at the same time, you are treated as having family coverage during that period. If, on the first day of the last month of your tax year, December 1 for most taxpayers, you had family coverage, check the “family” box.

Line 2

Include on line 2 only those amounts you, or others on your behalf, contributed to your HSA in 2014. Also, include those contributions made from January 1, 2015, through April 15, 2015, that were for 2014. Do not include employer contributions (see line 9) or amounts rolled over from another HSA or Archer MSA. See Rollovers, earlier. Also, do not include any qualified HSA funding distributions (see line 10). Contributions to an employee's account through a cafeteria plan are treated as employer contributions and are not included on line 2.

Line 3

When figuring the amount to enter on line 3, apply the following rules.

  1. Use the family coverage amount if you or your spouse had an HDHP with family coverage. Disregard any plan with self-only coverage.

  2. If the last-month rule (see Last-month rule, earlier) applies, you are considered an eligible individual for the entire year. You are treated as having the same HDHP coverage for the entire year as you had on the first day of the last month of your tax year.

  3. If you were, or were considered, an eligible individual for the entire year and you did not change your type of coverage, enter $3,300 for a self-only HDHP or $6,550 for a family HDHP on line 3. (See (6) in this list.)

  4. If you were, or were considered, an eligible individual for the entire year and you changed your type of coverage during the year, enter on line 3 (see (6) in this list) the greater of:

    1. The limitation shown on the last line of the Line 3 Limitation Chart and Worksheet, later or

    2. The maximum amount that can be contributed based on the type of HDHP coverage you had on the first day of the last month of your tax year.

      If you had family coverage on the first day of the last month, you do not need to use the worksheet; enter $6,550 on line 3.

  5. If you were not an eligible individual on the first day of the last month of your tax year, use the Line 3 Limitation Chart and Worksheet, later to determine the amount to enter on line 3. (See (6) in this list.)

  6. If, at the end of 2014, you were age 55 or older and unmarried or married with self-only HDHP coverage for the entire year, you can increase the amount determined in (3) or (4) by $1,000 (the additional contribution amount). For (5), the additional contribution amount is taken into account for each month you are an eligible individual.

    Note.

    If you are married and had family coverage at any time during the year, the additional contribution amount is figured on line 7 and is not included on line 3.

See Pub. 969 for more information.

If you must complete the Line 3 Limitation Chart and Worksheet, and your eligibility and coverage did not change from one month to the next, enter the same number you entered for the previous month.

Line 3 Limitation Chart and Worksheet

Line 3 Limitation Chart and Worksheet
Please click here for the text description of the image.

Line 3 Limitation Chart and Worksheet

Line 6

Spouses who have separate HSAs and had family coverage under an HDHP at any time during 2014, use the following rules to figure the amount on line 6.

  • If you are treated as having family coverage for each month, divide the amount on line 5 equally between you and your spouse, unless you both agree on a different allocation (such as allocating nothing to one spouse). Enter your allocable share on line 6.

    Example.

    In 2014, you are an eligible individual and have self-only HDHP coverage. In March you marry and as of April 1 you have family HDHP coverage. Neither you nor your spouse qualify for the additional contribution amount. Your spouse has a separate HSA and is an eligible individual from April 1 to December 31, 2014. Because you and your spouse are considered to have family coverage on December 1, your contribution limit is $6,550 (the family coverage maximum). You and your spouse can divide this amount in any allocation to which you agree (such as allocating nothing to one spouse).

  • If you are not treated as having family coverage for each month, use the following steps to determine the amount to enter on line 6.

Step 1.

Refigure the contribution limit that would have been entered on line 5 if you had entered on line 3 the total of the worksheet amounts only for the months you were treated as having family coverage. When refiguring line 5, use the same amount you previously entered on line 4.

Step 2.

Divide the refigured contribution limit from Step 1 equally between you and your spouse, unless you both agree on a different allocation (such as allocating nothing to one spouse).

Step 3.

Subtract the part of the contribution limit allocated to your spouse in Step 2 from the amount determined in Step 1.

Step 4.

Determine any other contribution limits that apply for the tax year and add that amount to the result in Step 3. Enter the total on line 6.

Example.

In 2014, you are an eligible individual and have family HDHP coverage. In March you divorce and change your coverage as of April 1 to self-only. Neither you nor your ex-spouse qualify for the additional contribution amount. Your ex-spouse continued to have family HDHP coverage and was an eligible individual for the entire year. The contribution limit for the 3 months you both were considered to have family coverage is $1,637.50 ($6,550 × 3 ÷ 12). You and your ex-spouse decide to divide the family coverage contribution in the following manner: 75% to your ex-spouse and 25% to you. Your contribution limit for 9 months of self-only coverage is $2,475.00 ($3,300 × 9 ÷ 12). This amount is not divided between you and your spouse.

Because you are covered under a self-only policy on December 1, you will show $3,300 on line 6 (the greater of either (a) $2,884.37 ($1,637.50 family coverage + $2,475.00 self-only coverage – $1,228.13 spousal allocation) or (b) the maximum amount that can be contributed ($3,300 for self-only coverage). Your ex-spouse would show $6,550 on line 6 (the greater of either (a) $6,140.62 ($1,637.50 family coverage for the 3 months prior to the divorce + $4,912.50 family coverage maintained after the divorce – $409.38 spousal allocation) or (b) the maximum amount that can be contributed ($6,550 for family coverage).

Line 7

Additional Contribution Amount

If, at the end of 2014, you were age 55 or older and married, use the Additional Contribution Amount Worksheet, later, if both of the following apply.

  1. You or your spouse had family coverage under an HDHP and were, or were considered to be, an eligible individual on the first day of the month.

  2. You were not enrolled in Medicare for the month.

Enter the result on line 7.

If items (1) and (2) apply to all months during 2014, enter $1,000 on line 7.

Additional Contribution Amount Worksheet

1. $1,000 × number of months eligible  
2. Divide line 1 by 12. Enter here and on line 7  

Example.

At the end of 2014, you were age 55 and married. You had family coverage under an HDHP from January 1 through June 30, 2014 (6 months). You were not enrolled in Medicare in 2014. You would enter an additional contribution amount of $500 on line 7 ($1,000 × 6 ÷ 12).

Line 9

Employer Contributions

Employer contributions (including contributions through a cafeteria plan) include any amount an employer contributes to any HSA for you for 2014. These contributions should be shown in box 12 of Form W-2 with code W. If either of the following apply, complete the Employer Contribution Worksheet.

  • Employer contributions for 2013 are included in the amount reported in box 12 of Form W-2 with code W.

  • Employer contributions for 2014 are made in 2015.

If your employer made excess contributions, you may have to report the excess as income. See Excess Employer Contributions, later.

Employer Contribution Worksheet

1. Enter the employer contributions reported in box 12 of Form W-2, with code W 1.    
2. Enter employer contributions made in 2014 for tax year 2013 2.    
3. Subtract line 2 from line 1 3.    
4. Enter employer contributions made in 2015 for tax year 2014 4.    
5. Employer contributions for 2014. Add lines 3 and 4. Enter here and on Form 8889, line 9 5.    
                     

Line 10

Enter on line 10 any qualified HSA funding distribution made during the year. This is a distribution from your traditional IRA or Roth IRA to your HSA in a direct trustee-to-trustee transfer. This distribution is not included in your income, is not deductible, and reduces the amount that can be contributed to your HSA. This distribution cannot be made from an ongoing SEP IRA or SIMPLE IRA. For this purpose, a SEP IRA or SIMPLE IRA is ongoing if an employer contribution is made for the plan year ending with or within your tax year in which the distribution would be made.

The maximum amount that can be excluded from income is based on your age at the end of the year and your HDHP coverage (self-only or family) at the time of the distribution. You can make only one qualified HSA funding distribution during your lifetime. However, if you make the distribution during a month when you have self-only HDHP coverage, you can make another qualified HSA funding distribution in a later month in that tax year if you change to family HDHP coverage.

A qualified HSA funding distribution made during your tax year reduces the amount that can be contributed from other sources (including employer contributions) to your HSA. See the discussions under Line 13 for the treatment of excess contributions.

See Pub. 969 for more information.

Testing period.

You must remain an eligible individual during the testing period. The testing period begins with the month in which the qualified HSA funding distribution is contributed to the HSA and ends on the last day of the 12th month following that month. For example, if the distribution is contributed on June 16, 2014, the testing period ends on June 30, 2015. If you fail to remain an eligible individual during this period, other than because of death or becoming disabled, you will have to include the qualified HSA funding distribution in income in the year in which you fail to be an eligible individual. This amount is also subject to a 10% additional tax. (See Part III.)

Line 13

If you or someone on your behalf (or your employer) contributed more to your HSA than is allowable, you may have to pay an additional tax on the excess contributions. Figure the excess contributions using the following instructions. See Form 5329, Additional Taxes on Qualified Plans (Including IRAs) and Other Tax-Favored Accounts, to figure the additional tax.

Excess Contributions You Make

To figure your excess contributions (including those made on your behalf), subtract your deductible contributions (line 13) from your actual contributions (line 2). However, you can withdraw some or all of your excess contributions for 2014 and they will be treated as if they had not been contributed if:

  • You make the withdrawal by the due date, including extensions, of your 2014 tax return (but see the Note under Excess Employer Contributions, later),

  • You do not claim a deduction for the amount of the withdrawn contributions, and

  • You also withdraw any income earned on the withdrawn contributions and include the earnings in “Other income” on your tax return for the year you withdraw the contributions and earnings.

Excess Employer Contributions

Excess employer contributions are the excess, if any, of your employer's contributions over your limitation on line 8. If you made a qualified HSA funding distribution (line 10) during the tax year, reduce your limitation (line 8) by that distribution before you determine whether you have excess employer contributions. If the excess was not included in income on Form W-2, you must report it as “Other income” on your tax return. However, you can withdraw some or all of the excess employer contributions for 2014 and they will be treated as if they had not been contributed if:

  • You make the withdrawal by the due date, including extensions, of your 2014 tax return (but see the following Note),

  • You do not claim an exclusion from income for the amount of the withdrawn contributions, and

  • You also withdraw any income earned on the withdrawn contributions and include the earnings in “Other income” on your tax return for the year you withdraw the contributions and earnings.

Note.

If you timely filed your return without withdrawing the excess contributions, you can still make the withdrawal no later than 6 months after the due date of your tax return, excluding extensions. If you do, file an amended return with “Filed pursuant to section 301.9100-2” written at the top. Include an explanation of the withdrawal. Make all necessary changes on the amended return (for example, if you reported the contributions as excess contributions on your original return, include an amended Form 5329 reflecting that the withdrawn contributions are no longer treated as having been contributed).

Deducting an Excess Contribution in a Later Year

You may be able to deduct excess contributions for previous years that are still in your HSA. The excess contributions you can deduct in the current year is the lesser of the following two amounts.

  • Your maximum HSA contribution limit for the year minus any amounts contributed to your HSA for the year.

  • The total excess contributions in your HSA at the beginning of the year.

Any excess contribution remaining at the end of the tax year is subject to the additional tax. See Form 5329.

Part II—HSA Distributions

Line 14a

Enter the total distributions you received in 2014 from all HSAs. Your total distributions include amounts paid with a debit card that restricts payments to health care and amounts withdrawn by other individuals that you have designated. These amounts should be shown in box 1 of Form 1099-SA.

Line 14b

Include on line 14b any distributions you received in 2014 that qualified as a rollover contribution to another HSA. See Rollovers, earlier. Also include any excess contributions (and the earnings on those excess contributions) included on line 14a that were withdrawn by the due date, including extensions, of your return. See the instructions for line 13, earlier.

Line 15

Only include on line 15 distributions from your HSA that were used to pay you for qualified medical expenses (see Qualified Medical Expenses, earlier) not reimbursed by insurance or other coverage and that you incurred after the HSA was established. Do not include the distribution of an excess contribution taken out after the due date, including extensions, of your return even if used for qualified medical expenses.

In general, include on line 15 distributions from all HSAs in 2014 that were used for the qualified medical expenses (see Qualified Medical Expenses, earlier) of:

  1. Yourself and your spouse.

  2. All dependents you claim on your tax return.

  3. Any person you could have claimed as a dependent on your return except that:

    1. The person filed a joint return.

    2. The person had gross income of $3,950 or more.

    3. You, or your spouse if filing jointly, could be claimed as a dependent on someone else's return.

For this purpose, a child of parents that are divorced, separated, or living apart for the last 6 months of the calendar year is treated as the dependent of both parents whether or not the custodial parent releases the claim to the child's exemption.

You cannot take a deduction on Schedule A (Form 1040) for any amount you include on line 15.

Lines 17a and 17b

Additional 20% Tax

HSA distributions included in income (line 16) are subject to an additional 20% tax unless one of the following exceptions applies.

Exceptions to the Additional 20% Tax

The additional 20% tax does not apply to distributions made after the account beneficiary—

  • Dies,

  • Becomes disabled (see Disabled, earlier), or

  • Turns age 65.

If any of the exceptions apply to any of the distributions included on line 16, check the box on line 17a. Enter on line 17b only 20% (.20) of any amount included on line 16 that does not meet any of the exceptions.

Example 1. You turned age 63 in 2014 and received a distribution from an HSA that is included in income. Do not check the box on line 17a because you (the account beneficiary) did not meet the age exception for the distribution. Enter 20% of the amount from line 16 on line 17b.

Example 2. You turned age 65 in 2014. You received distributions that are included in income both before and after you turned age 65. Check the box on line 17a because the additional 20% tax does not apply to the distributions made after the date you turned age 65. However, the additional 20% tax does apply to the distributions made on or before the date you turned age 65. Enter on line 17b, 20% of the amount of these distributions included in line 16.

Part III—Income and Additional Tax for Failure to Maintain HDHP Coverage

Use Part III to figure any income and additional tax that must be reported on Form 1040 or Form 1040NR for failure to be an eligible individual during the testing period for:

  • Last-month rule (see Last-month rule, earlier), or

  • A qualified HSA funding distribution (see the instructions for line 10, earlier).

 
 
See the discussions indicated to determine the testing period for these items. Include the amount in income in the year in which you fail to be an eligible individual.

Line 18

You can use the Line 3 Limitation Chart and Worksheet for the year the contribution was made to determine the contribution you could have made if the last-month rule did not apply. Enter on line 18 the excess of the amount contributed over the redetermined amount. Examples of this computation are in Pub. 969.

Line 19

Enter the total of any qualified HSA funding distribution (see Line 10).


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