Do not include employer. If you were under age 55 at the end of , and on the first day of every month during ,. All others, see the instructions for the amount to enter. If you or your spouse had family coverage under an HDHP at any time. If zero or less, enter Enter the amount from line 5. But if you and your spouse each have separate HSAs and had. If you were age 55 or older at the end of , married, and you or your spouse had family.
HSA deduction. Enter the smaller of line 2 or line 12 here and on Form , line 25, or Form. Caution: If line 2 is more than line 13, you may have to pay an additional tax see instructions. HSA Distributions. If you are filing jointly and both you and your spouse each have separate HSAs, complete.
Distributions included on line 14a that you rolled over to another HSA. Taxpayers get tax-free distributions from an HSA to make them pay or reimburse for qualified medical costs. The taxpayer is going to make to tell you the types of costs reimbursed or paid with the distribution.
Buy PDFelement right now! Margarete Cotty. Try It Free. Margarete Cotty chief Editor. See Form Enter the total distributions you received in 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 Your total distributions include amounts paid with a debit card that restricts payments to health care and amounts withdrawn by other individuals that you have designated.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 SA. Include on line 14b any distributions you received in that qualified as a rollover contribution to another HSA. Also include any excess contributions and the earnings on those excess contributions included on line 14a that were withdrawn by the due date, including extensions, of your return.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. 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 that were used for the qualified medical expenses see Qualified Medical Expenses , earlier of:.
For this purpose, a child of parents who 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 claim to the child as his or her dependent. You cannot take a deduction on Schedule A Form for any amount you include on line If any of the exceptions apply to any of the distributions included on line 16, check the box on line 17a.
You turned age 63 in 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. You turned age 65 in You received distributions that are included in income both before and after you turned age Use Part III to figure any income and additional tax that must be reported on Schedule 1 Form and Schedule 2 Form for failure to be an eligible individual during the testing period for:.
A qualified HSA funding distribution see the Instructions for line 10 , earlier. You can use the Line 3 Limitation Chart and Worksheet in these instructions 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.
Home Instructions Instructions for Form Telehealth and other remote care. General Instructions Purpose of Form Additional information. Testing period. Safe harbor for telehealth. Certain coverage disregarded. Permitted insurance. Step 2. Step 3. Step 4. Section references are to the Internal Revenue Code unless otherwise noted. Instructions for Form - Introductory Material. Future Developments. Expansion of qualified medical expenses. In the case of plan years beginning before An eligible individual may have separate coverage for telehealth and other remote care in addition to a high deductible health plan.
General Instructions. Report health savings account HSA contributions including those made on your behalf and employer contributions , Figure your HSA deduction, Report distributions from HSAs, and Figure amounts you must include in income and additional tax you may owe if you fail to be an eligible individual. Additional information. You received HSA distributions in Last-month rule.
Account Beneficiary. Distributions From an HSA. Qualified Medical Expenses. Long-term care LTC insurance, Health care continuation coverage such as coverage under COBRA , Health care coverage while receiving unemployment compensation under federal or state law, or Medicare and other health care coverage if you were 65 or older other than premiums for a Medicare supplemental policy, such as Medigap.
High Deductible Health Plan. Instead, only deductibles and out-of-pocket expenses such as copayments and other amounts, but not premiums for services within the network should be used to figure whether the limit is reached. Safe harbor for preventive care. An eligible individual may have: Coverage for any benefit provided by permitted insurance, and Coverage whether through insurance or otherwise for accidents, disability, dental care, vision care, or long-term care, or in the case of plan years beginning before telehealth and other remote care.
Death of Account Beneficiary. Complete the rest of Part II. Specific Instructions. Name and social security number SSN. 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.
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: The limitation shown on the last line of the Line 3 Limitation Chart and Worksheet in these instructions , or 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.
Line 3 Limitation Chart and Worksheet Line 3 Limitation Chart and Worksheet Summary: This flowchart is used to determine the amount of deductible limitation for each month. Start This is the starting of the flowchart. Decision 1 Were you enrolled in Medicare for the month?
Continue To End Decision 2 Were you an eligible individual see page 1 of the instructions on the first day of the month? Continue To End End This is the ending of the flowchart.
Additional Contribution Amount. You were not enrolled in Medicare for the month. Divide line 1 by Employer Contributions. Employer contributions for are made in Enter the employer contributions reported in box 12 of Form W-2, with code W 1. Enter employer contributions made in for tax year 2. Subtract line 2 from line 1 3. Enter employer contributions made in for tax year 4. Employer contributions for Add lines 3 and 4. Enter here and on Form , line 9 5. Qualified HSA funding distribution.
Excess Contributions You Make. You make the withdrawal by the due date, including extensions, of your 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. You make the withdrawal by the due date, including extensions, of your 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.
Deducting an Excess Contribution in a Later Year. The total excess contributions in your HSA at the beginning of the year.
You and your spouse. All your dependents. Any person who would be a dependent except that: The person filed a joint return.
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