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The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.
Note. If you instruct the trustee of your Archer MSA to
transfer funds directly to the trustee of another of your
Archer MSAs, the transfer isn't considered a rollover.
There is no limit on the number of these transfers. Don't
include the amount transferred in income, deduct it as a
contribution, or include it as a distribution on line 6a.
Line 7
In general, include on line 7 distributions from all Archer
MSAs in 2023 that were used for the qualified medical
expenses (see
Qualified Medical Expenses, earlier) of:
1. Yourself and your spouse;
2. All your dependents; and
3. Any person who would be your dependent except
that:
a. The person filed a joint return;
b. The person had gross income of $4,700 or more; or
c. You, or your spouse if filing jointly, are dependents
of someone else.
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 the claim to the child as their dependent.
However, if you or your employer made a contribution to
your Archer MSA in 2023 and you used withdrawals to pay
expenses for an individual who wasn't covered by an
HDHP or was covered by a plan that wasn't an HDHP
(other than the exceptions listed under
Other Health
Coverage, earlier) at the time the expenses were incurred,
then you shouldn't include those withdrawals on line 7.
Example. In 2023, you were covered by an HDHP with
self-only coverage and your spouse was covered by a
health plan that wasn't an HDHP. You made contributions
to an Archer MSA for 2023. You can't include on line 7
withdrawals made from the Archer MSA to pay your
spouse's medical expenses incurred in 2023 because
your spouse was covered by a plan that wasn't an HDHP.
You can't take a deduction on Schedule A (Form
1040) or Schedule A (Form 1040-NR) for any
amount you include on line 7.
Lines 9a and 9b
Additional 20% Tax
Archer MSA distributions included in income (line 8) are
subject to an additional 20% tax unless one of the
following exceptions applies.
Exceptions to the Additional 20% Tax
The additional 20% tax doesn't apply to distributions
made after the date that the account holder:
•
Dies,
•
Becomes disabled (see Disabled, earlier), or
•
Turns age 65.
If any of the exceptions applies to any of the distributions
included on line 8, check the box on line 9a. Enter on
line 9b only 20% (0.20) of any amount included on line 8
that doesn't meet any of the exceptions.
Example 1. You turned age 66 in 2023 and had no
Archer MSA during 2023. Your spouse turned age 63 in
2023 and received a distribution from an Archer MSA that
is included in income. Don't check the box on line 9a
because your spouse (the account holder) didn't meet the
age exception for the distribution. Enter 20% of the
amount from line 8 on line 9b.
Example 2. Both you and your spouse received
distributions from your Archer MSAs in 2023 that are
included in income. You were age 65 at the time you
received the distributions and your spouse was age 63
when they received the distributions. Check the box on
line 9a because the additional 20% tax doesn't apply to
the distributions you received (because you met the age
exception). However, the additional 20% tax does apply to
your spouse's distributions. Enter on line 9b only 20% of
the amount of your spouse's distributions included on
line 8.
Example 3. You turned age 65 in 2023. You received
distributions that are included in income both before and
after you turned age 65. Check the box on line 9a because
the additional 20% tax doesn't 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 9b,
20% of the amount of these distributions included on
line 8.
Section B—Medicare Advantage MSA
Distributions
Complete Section B if you (or your spouse, if filing jointly)
received distributions from a Medicare Advantage MSA in
2023. If both you and your spouse received distributions,
complete a separate Form 8853, Section B, for each
spouse. Enter “statement” across the top of each Form
8853, fill in the name and SSN, and complete Section B.
Next, add lines 10, 11, 12, and 13b from the two
statement Forms 8853 and enter those totals on the
respective lines of the controlling Form 8853 (the
combined Form 8853 for both spouses). If either spouse
checked the box on line 13a of the statement Form 8853,
check the box on the controlling Form 8853. Attach the
two statement Forms 8853 to your paper tax return after
the controlling Form 8853.
If you (or your spouse, if filing jointly) received
distributions from a Medicare Advantage MSA in
2023, you must file Form 8853 with a Form 1040,
1040-SR, or 1040-NR even if you have no taxable income
or any other reason for filing Form 1040, 1040-SR, or
1040-NR.
Medicare Advantage MSA
A Medicare Advantage MSA is an Archer MSA designated
as a Medicare Advantage MSA to be used solely to pay
the qualified medical expenses of the account holder. To
be eligible for a Medicare Advantage MSA, you must be
enrolled in Medicare and have an HDHP that meets the
Medicare guidelines. Contributions to the account can be
made only by Medicare. The contributions and any
earnings, while in the account, aren't taxable to the
-6-
Instructions for Form 8853 (2023)