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Department of the Treasury
Internal Revenue Service
2024

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. Specific Instructions for Form
Future Developments 1099-SA
For the latest information about developments related to File Form 1099-SA, Distributions From an HSA, Archer
Forms 1099-SA and 5498-SA and their instructions, such MSA, or Medicare Advantage MSA, to report distributions
as legislation enacted after they were published, go to made from a health savings account (HSA), Archer
IRS.gov/Form1099SA and IRS.gov/Form5498SA. medical savings account (Archer MSA), or Medicare
Advantage MSA (MA MSA). The distribution may have
Reminders been paid directly to a medical service provider or to the
In addition to these specific instructions, you should also account holder. A separate return must be filed for each
use the 2024 General Instructions for Certain Information plan type.
Returns. Those general instructions include information
about the following topics. Transfers
• Who must file. Do not report a trustee-to-trustee transfer from one Archer
• When and where to file. MSA or MA MSA to another Archer MSA or MA MSA,
• Electronic reporting. from an Archer MSA to an HSA, or from one HSA to
• Corrected and void returns. another HSA. For reporting purposes, contributions and
• Statements to recipients. rollovers do not include transfers.
• Taxpayer identification numbers (TINs).
• Backup withholding. HSA Mistaken Distributions
• Penalties. If amounts were distributed during the year from an HSA
• Other general topics. because of a mistake of fact due to reasonable cause, the
account beneficiary may repay the mistaken distribution
You can get the general instructions from IRS.gov/ no later than the due date of the tax return (not counting
1099GeneralInstructions IRS.gov/Form1099SA, , and extensions) following the first year the account beneficiary
IRS.gov/Form5498SA. knew or should have known the distribution was a
Continuous-use form and instructions. Form 1099-SA mistake. For example, the account beneficiary reasonably,
and its instructions are continuous use. Both the form and but mistakenly, believed that an expense was a qualified
instructions will be updated as needed. For the most medical expense and was reimbursed for that expense
recent version, go to IRS.gov/Form1099SA. from the HSA. The account beneficiary then repays the
mistaken distribution to the HSA.
E-filing returns. The Taxpayer First Act of 2019
authorized the Department of the Treasury and the IRS to Under these circumstances, the mistaken distribution is
issue regulations that reduce the 250-return e-file not included in gross income, is not subject to the
threshold. T.D. 9972, published February 23, 2023, additional 20% tax, and the repayment is not subject to
lowered the e-file threshold to 10 (calculated by the excise tax on excess contributions. Do not treat the
aggregating all information returns), effective for repayment as a contribution on Form 5498-SA, HSA,
information returns required to be filed on or after January Archer MSA, or Medicare Advantage MSA Information.
1, 2024. Go to IRS.gov/InfoReturn for e-file options. As the trustee or custodian, you do not have to
Online fillable forms. Due to the very low volume of TIP allow beneficiaries to return a mistaken
paper Forms 1099-SA and 5498-SA received and distribution to the HSA. However, if you do allow
processed by the IRS each year, these forms have been the return of the mistaken distribution, you may rely on the
converted to an online fillable format. You may fill out the account beneficiary's statement that the distribution was
forms, found online at IRS.gov/Form1099SA and IRS.gov/ in fact a mistake. See Notice 2004-50, 2004-33 I.R.B. 196,
Form5498SA, and send Copy B to the recipient. Q&A 76, available at IRS.gov/irb/
2004-33_IRB#NOT-2004-50. Do not report the mistaken
For Forms 1099-SA and 5498-SA only, if due to distribution on Form 1099-SA. Correct any filed Form
! a low volume of recipients, you are filing the 1099-SA with the IRS and the account beneficiary as soon
CAUTION form(s) on paper, you can send in the
as you become aware of the error. See Corrected Returns
black-and-white Copy(ies) A with a Form 1096 that you
also printed from the IRS website.

Aug 14, 2023 Cat. No. 38470S

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on Paper Forms in the current General Instructions for decedent's qualified medical expenses, if paid within 1
Certain Information Returns for more information. year after death.
HSAs. When the account holder dies, the following
HSA Closure Under the USA PATRIOT Act applies.
If an HSA is closed at any time by the HSA trustee or • If the designated beneficiary is the surviving spouse,
custodian due to a failure of the participant to satisfy the the spouse becomes the account holder of the HSA.
Customer Identification Program requirements described • If the designated beneficiary is not the surviving
in section 326 of the USA PATRIOT Act, the distribution spouse, the account ceases to be an HSA on the date of
from the HSA must be reported. the account holder's death. The FMV of the account as of
the date of death is required to be reported in box 4.
If a regular contribution is made to the HSA that is Follow the rules and coding above under Distribution in
closed, and a distribution is made to the participant, enter year of death and Distribution after year of death.
the gross distribution in box 1. If no earnings are
distributed, enter zero in box 2. If earnings are distributed, Statements to Recipients
enter the amount of earnings in box 2. Enter code 2 in If you are required to file Form 1099-SA, you must provide
box 3. See the instructions for boxes 1 through 3, later. a statement to the recipient. For more information about
the requirement to furnish a Form 1099-SA or acceptable
In addition, Form 5498-SA must be filed to report any substitute statement to recipients, see part M in the
rollover (qualified HSA funding distributions current General Instructions for Certain Information
(trustee-to-trustee transfers from an individual retirement Returns.
arrangement (IRA) to an HSA under section 408(d)(9)))
contributions to the HSA subsequently closed by the Truncating Recipient's TIN on Payee Statements
trustee or custodian. See the Specific Instructions for
Pursuant to Regulations section 301.6109-4, all filers of
Form 5498-SA, later.
this form may truncate a recipient’s TIN (social security
Death of Account Holder number (SSN), individual taxpayer identification number
(ITIN), adoption taxpayer identification number (ATIN), or
Archer MSAs and MA MSAs. When the account holder employer identification number (EIN)) on payee
dies and the designated beneficiary is the surviving statements. Truncation is not allowed on any documents
spouse, the following apply. the filer files with the IRS. A trustee's/payer's TIN may not
• The spouse becomes the account holder of the Archer be truncated on any form. See part J in the current
MSA. General Instructions for Certain Information Returns.
• An MA MSA is treated as an Archer MSA of the spouse
for distribution purposes. Account Number
• Distributions from these accounts are subject to the The account number is required if you have multiple
rules that apply to Archer MSAs. accounts for a recipient for whom you are filing more than
If the designated beneficiary is not the spouse or there one Form 1099-SA. Additionally, the IRS encourages you
is no named beneficiary, the account ceases to be an to designate an account number for all Forms 1099-SA
MSA as of the date of death and the fair market value that you file. See part L in the current General Instructions
(FMV) on that date is reported. for Certain Information Returns.
If there is more than one recipient, the FMV should be
Box 1. Gross Distribution
allocated among them, as appropriate.
Enter the total amount of the distribution. Include any
If the beneficiary is the estate, enter the estate's name earnings separately reported in box 2. You are not
and TIN in place of the recipient's on the form. required to determine the taxable amount of a distribution.
Distribution in year of death. If you learn of the Do not report a negative amount in box 1. Do not report
account holder's death and make a distribution to the the withdrawal of excess employer contributions (and the
beneficiary in the year of death, issue a Form 1099-SA earnings on them) returned to an employer as a
and enter in: distribution from an employee's HSA. Do not report
• Box 1, the gross distribution; excess MA MSA contributions returned to the Secretary of
• Box 3, code 4 (see Box 3. Distribution Code, later); and Health and Human Services or their representative.
• Box 4, the FMV of the account on the date of death.
Distribution after year of death. If you learn of the Box 2. Earnings on Excess Contributions
death of the account holder and make a distribution after Enter the total earnings distributed with any excess HSA
the year of death, issue a Form 1099-SA in the year you or Archer MSA contributions returned by the due date of
learned of the death of the account holder. Enter in: the account holder's tax return. Include this amount in
• Box 1, the gross distribution; box 1. Report earnings on other distributions only in box 1.
• Box 3, one of the following codes (see Box 3.
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; and
• Box 4, the FMV of the account on the date of death,
reduced by any payments from the HSA made for the

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For HSAs and Archer MSAs, if you are reporting Box 3. Distribution Code
TIP earnings on a distribution of excess contributions, Enter the appropriate distribution code from the following
use the method under Regulations section list that shows the type of distribution.
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.

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
2—Excess contributions
MSA contributions to the account holder.
Use this code if you made distributions after the account
3—Disability
holder was disabled (see section 72(m)(7)).
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
6—Death distribution after year of death to a nonspouse
beneficiary, other than an estate, after the year of death.
beneficiary
Do not use with code 4.

Box 4. FMV on Date of Death Transfers
Enter the FMV of the account on the date of death. See Do not report a trustee-to-trustee transfer from one Archer
Death of Account Holder, earlier. MSA or MA MSA to another Archer MSA or MA MSA,
from an Archer MSA to an HSA, or from one HSA to
Box 5. Checkbox another HSA. For reporting purposes, contributions and
Check the box to indicate if this distribution was from an rollovers do not include these transfers. However, see Box
HSA, Archer MSA, or MA MSA. 2, later, for the reporting of a trustee-to-trustee transfer
from an IRA to an HSA.

Specific Instructions for Form Total Distribution, No Contributions
5498-SA Generally, if a total distribution was made from an HSA or
File Form 5498-SA, HSA, Archer MSA, or Medicare Archer MSA during the year and no contributions were
Advantage MSA Information, with the IRS on or before made for that year, you need not file Form 5498-SA nor
June 2, 2025, for each person for whom you maintained a furnish a statement to the participant to reflect that the fair
health savings account (HSA), Archer medical savings market value (FMV) on December 31 was zero.
account (Archer MSA), or Medicare Advantage MSA (MA
MSA) during 2024. You are required to file if you are the Death of Account Holder
trustee or custodian of an HSA, Archer MSA, or MA MSA. In the year an HSA, Archer MSA, or MA MSA owner dies,
A separate form is required for each type of plan. you must generally file a Form 5498-SA and furnish a
statement for the decedent. If the designated beneficiary
For HSA or Archer MSA contributions made between is the surviving spouse, the following apply.
January 1, 2025, and April 15, 2025, you should obtain • The spouse becomes the account holder of the HSA or
the participant's designation of the year for which the Archer MSA.
contributions are made. • An MA MSA is treated as an Archer MSA of the spouse
for distribution purposes, but no new contributions may be
For repayment of a mistaken distribution amount, see
made to the account.
HSA Mistaken Distributions, earlier. Do not treat the
repayment as a contribution on Form 5498-SA. If the designated beneficiary is not the spouse or there
is no designated beneficiary, the account ceases to be an
Rollovers HSA, Archer MSA, or MA MSA.
You must report the receipt of a rollover from one Archer
MSA to another Archer MSA, and the receipt of a rollover
from an Archer MSA or an HSA to an HSA in box 4.

Instructions for Forms 1099-SA and 5498-SA (2024) -3-

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Statements to Participants Box 1. Employee or Self-Employed Person's
If you are required to file Form 5498-SA, you must provide Archer MSA Contributions Made in 2024 and
a statement to the participant (generally Copy B) by June 2025 for 2024
2, 2025. You may, but you are not required to, provide the Enter the employee's or self-employed person's regular
participant with a statement of the December 31, 2024, contributions to the Archer MSA made in 2024 and
FMV of the participant's account by January 31, 2025. For through April 15, 2025, for 2024. Report gross
more information about statements to participants, see contributions, including any excess contributions, even if
part M in the 2024 General Instructions for Certain the excess contributions were withdrawn. No HSA
Information Returns. information is to be reported in box 1.

If you furnished a statement of the FMV of the account Box 2. Total Contributions Made in 2024
to the participant by January 31, 2025, and no reportable
contributions, including rollovers, were made for 2024, you Enter the total HSA or Archer MSA contributions made in
need not furnish another statement (or Form 5498-SA) to 2024. Include any contribution made in 2024 for 2023.
the participant to report zero contributions. However, you Also include qualified HSA funding distributions
must file Form 5498-SA with the IRS by June 2, 2025, to (trustee-to-trustee transfers from an IRA to an HSA under
report the December 31, 2024, FMV of the account. section 408(d)(9)) received by you during 2024. Any
excess employer contributions (and the earnings on them)
If you do not furnish another statement to the withdrawn by the employer pursuant to Notice 2008-59,
! participant because no reportable contributions Q&A 24, available at IRS.gov/irb/
CAUTION were made for the year, the statement of the FMV 2008-29_IRB#NOT-2008-59, should not be reported as a
of the account must contain a legend designating which contribution. You may, but you are not required to, report
information is being furnished to the IRS. the total MA MSA contributions made in 2024 by the
Secretary of Health and Human Services or their
Truncating Participant's TIN on Payee representative. Do not include amounts reported in box 4.
Statements
Box 3. Total HSA or Archer MSA Contributions
Pursuant to Regulations section 301.6109-4, all filers of
Made in 2025 for 2024
this form may truncate a participant's TIN (social security
number (SSN), individual taxpayer identification number Enter the total HSA or Archer MSA contributions made in
(ITIN), adoption taxpayer identification number (ATIN), or 2025 for 2024.
employer identification number (EIN)) on payee
Box 4. Rollover Contributions
statements. Truncation is not allowed on any documents
the filer files with the IRS. A trustee's TIN may not be Enter rollover contributions to the HSA or Archer MSA
truncated on any form. See part J in the 2024 General received by you during 2024. These amounts are not to be
Instructions for Certain Information Returns. included in box 2.

Account Number Box 5. Fair Market Value of HSA, Archer MSA, or
The account number is required if you have multiple MA MSA
accounts for a recipient for whom you are filing more than Enter the FMV of the account on December 31, 2024.
one Form 5498-SA. Additionally, the IRS encourages you
to designate an account number for all Forms 5498-SA Box 6. Checkbox
that you file. See part L in the 2024 General Instructions Check the box to indicate if this account is an HSA, Archer
for Certain Information Returns. MSA, or MA MSA.

-4- Instructions for Forms 1099-SA and 5498-SA (2024)

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