Form 1099-SA: HSA Distributions Explained

If you took money out of an HSA (the account used with a high-deductible health plan), an Archer medical account, or a Medicare Advantage MSA, the trustee reports it on Form 1099-SA. The form is a record of the withdrawal. It does not say whether the money is taxable. You decide that when you prepare your return.

This guide explains the boxes, the rules that make a withdrawal not taxable, and where the amounts go.

IRS: Form 1099-SA (Rev. April 2025)

What the boxes mean

Box 1 is the gross amount you received this year. It may have been paid straight to your medical provider or paid to you.
Box 2 is the earnings on any excess contributions you withdrew. You withdraw those by the due date of your return.
Box 3 is a distribution code. Code 1 is a normal distribution. Code 2 is an excess contribution. Code 3 is a disability distribution. Code 4 is a death distribution other than code 6. Code 5 is a prohibited transaction. Code 6 is a death distribution after the year of death to a nonspouse beneficiary.
Box 4 is the fair market value of the account on the date of death, if the account holder died.
Box 5 shows the type of account: HSA, Archer MSA, or MA MSA.

When a withdrawal is not taxable

An HSA or Archer MSA withdrawal is not taxable if you used it to pay qualified medical expenses of the account holder or an eligible family member. It is also not taxable if you rolled it over. An HSA can roll over to another HSA. An Archer MSA can roll over to another Archer MSA or to an HSA.

An MA MSA withdrawal is not taxable if you used it to pay qualified medical expenses of the account holder only.

If you did not use the money for qualified medical expenses, and you did not roll it over, the amount must be included in your income. The form's instructions say you may also owe a penalty. The Form 8889 or Form 8853 instructions explain the details.

Which form reports it

HSA: Form 8889, filed with your Form 1040 or 1040-SR. Read Form 8889: How to Report Your HSA on Your Return.
Archer MSA or MA MSA: Form 8853, filed with your return.

The form itself says to use Form 8853 or Form 8889 for these accounts, even if the withdrawal is not taxable. Filing the right form is how the IRS sees the withdrawal was used correctly.

Mistaken withdrawals

If you took an HSA distribution by mistake, you can repay it. The IRS form says you may repay it no later than the due date of your return (not counting extensions) for the year after you first knew, or should have known, that the distribution was a mistake. The trustee must allow the repayment.

Excess contributions and the excise tax

If an excess contribution stays in the account, the instructions say an excise tax of 6% for each tax year applies. Form 5329 reports it. Earnings on excess contributions that you withdrew are included in Box 1. Include them on the "Other income" line of your return.

When the account holder died

The rules depend on who inherited the account. A spouse beneficiary has special rules. A nonspouse beneficiary must report the fair market value of the account on the date of death as income on their return for the year the owner died, even if the money was paid out in a later year. Box 1 minus Box 4 shows the earnings after the date of death, which are taxable. The Form 8853 and Form 8889 instructions cover the details.

What to do with it

Match Box 1 with your own payment records.
Check Box 3 for the right code.
Keep Copy B with your tax records.
Ask the trustee if a box looks wrong. The trustee's phone number and name are on the form.

A 1099-SA is a record. The tax answer comes from how you used the money.

Sources: Sources: IRS, Form 1099-SA (Rev. April 2025) and its general instructions (https://www.irs.gov/pub/irs-pdf/f1099sa.pdf); IRS Instructions for Form 8889 and Form 8853 (linked from the 1099-SA form) This is general information, not advice about your specific return.

← Back to the blog · Leer en español