Instructions for Forms 1099-SA and 5498-SA (Rev. December 2026)

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Instructions for Forms
1099-SA and 5498-SA
(Rev. December 2026)

(Use with the April 2025 revision of Form 1099-SA and the December 2026 revision
of Form 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.

Future Developments
For the latest information about developments related to
Forms 1099-SA and 5498-SA and their instructions, such
as legislation enacted after they were published, go to
IRS.gov/Form1099SA and IRS.gov/Form5498SA.
You can get Pub. 1099, General Instructions for Certain
Information Returns, at IRS.gov/1099GeneralInstructions.

What’s New
Address fields. For the Trustee’s and Participant’s
information, we separated the address fields into
individual entry boxes on Form 5498-SA.
Continuous-use revisions. Use the April 2025 revision
of Form 1099-SA, the December 2026 revision of Form
5498-SA, and these instructions to file and furnish 2026
information in early 2027. Continue to use these revisions
for subsequent years until we issue a superseding
revision. Do not use these revisions for prior years.

Reminders
In addition to these specific instructions, you should use
the current Pub. 1099, General Instructions for Certain
Information Returns, at IRS.gov/1099GeneralInstructions.
Those general instructions include information about the
following topics.
• Who must file.
• When and where to file.
• Electronic reporting.
• Corrected and void returns.
• Statements to recipients.
• Taxpayer identification numbers (TINs).
• Backup withholding.
• Penalties.
• Other general topics.
E-filing returns. The Taxpayer First Act of 2019
authorized the Department of the Treasury and the IRS to
issue regulations that reduce the 250-return e-file
threshold. T.D. 9972, published February 23, 2023,
lowered the e-file threshold to 10 (calculated by
aggregating all information returns), effective for
information returns required to be filed on or after January
1, 2024. Go to IRS.gov/InfoReturn for e-file options.
Dec 22, 2025

Information Returns Intake System (IRIS). The IRS
has developed IRIS, an online portal for e-filing
information returns. Go to IRS.gov/IRIS for more
information.
Online fillable forms. Due to the very low volume of
paper Forms 1099-SA and 5498-SA received and
processed by the IRS each year, these forms have been
converted to an online fillable format. You may fill out the
forms, found online at IRS.gov/Form1099SA and IRS.gov/
Form5498SA, and send Copy B to the recipient.
Caution: For Forms 1099-SA and 5498-SA only, if
due to a low volume of recipients, you are filing the form(s)
on paper, you can send in the black-and-white Copy(ies)
A with a Form 1096 that you also printed from the IRS
website.

Specific Instructions for Form
1099-SA

File Form 1099-SA, Distributions From an HSA, Archer
MSA, or Medicare Advantage MSA, to report distributions
made from a health savings account (HSA), Archer
medical savings account (Archer MSA), or Medicare
Advantage MSA (MA MSA). The distribution may have
been paid directly to a medical service provider or to the
account holder. A separate return must be filed for each
plan type.

Transfers

Do not report a trustee-to-trustee transfer from one Archer
MSA or MA MSA to another Archer MSA or MA MSA,
from an Archer MSA to an HSA, or from one HSA to
another HSA. For reporting purposes, contributions and
rollovers do not include transfers.

HSA Mistaken Distributions

If amounts were distributed during the year from an HSA
because of a mistake of fact due to reasonable cause, the
account beneficiary may repay the mistaken distribution
no later than the due date of the tax return (not counting
extensions) following the first year the account beneficiary
knew or should have known the distribution was a
mistake. For example, the account beneficiary reasonably,
but mistakenly, believed that an expense was a qualified
medical expense and was reimbursed for that expense
from the HSA. The account beneficiary then repays the
mistaken distribution to the HSA.

Instructions for Form 1099-SA and Form 5498-SA (Rev. 12-2026) Catalog Number 38470S
Department of the Treasury Internal Revenue Service www.irs.gov

Under these circumstances, the mistaken distribution is
not included in gross income, is not subject to the
additional 20% tax, and the repayment is not subject to
the excise tax on excess contributions. Do not treat the
repayment as a contribution on Form 5498-SA, HSA,
Archer MSA, or Medicare Advantage MSA Information.
Tip: As the trustee or custodian, you do not have to allow
beneficiaries to return a mistaken distribution to the HSA.
However, if you do allow the return of the mistaken
distribution, you may rely on the account beneficiary’s
statement that the distribution was a mistake. See Notice
2004-50, 2004-33 I.R.B. 196, Q&A 76, available
atIRS.gov/irb/2004-33_IRB#NOT-2004-50. Do not report
the mistaken distribution on Form 1099-SA. Correct any
filed Form 1099-SA with the IRS and the account
beneficiary as soon as you become aware of the error.
See Corrected Returns on Paper Forms in the current
Pub. 1099 for more information.

HSA Closure Under the USA PATRIOT Act

If an HSA is closed at any time by the HSA trustee or
custodian due to a failure of the participant to satisfy the
Customer Identification Program requirements described
in section 326 of the USA PATRIOT Act, the distribution
from the HSA must be reported.
If a regular contribution is made to the HSA that is
closed, and a distribution is made to the participant, enter
the gross distribution in box 1. If no earnings are
distributed, enter zero in box 2. If earnings are distributed,
enter the amount of earnings in box 2. Enter code 2 in
box 3. See the instructions for boxes 1 through 3, later.
In addition, Form 5498-SA must be filed to report any
rollover (qualified HSA funding distributions
(trustee-to-trustee transfers from an individual retirement
arrangement (IRA) to an HSA under section 408(d)(9)))
contributions to the HSA subsequently closed by the
trustee or custodian. See the Specific Instructions for
Form 5498-SA, later.

Death of Account Holder
Archer MSAs and MA MSAs. When the account holder
dies and the designated beneficiary is the surviving
spouse, the following apply.
• The spouse becomes the account holder of the Archer
MSA.
• An MA MSA is treated as an Archer MSA of the spouse
for distribution purposes.
• Distributions from these accounts are subject to the
rules that apply to Archer MSAs.
If the designated beneficiary is not the spouse or there
is no named beneficiary, the account ceases to be an
MSA as of the date of death and the fair market value
(FMV) on that date is reported.
If there is more than one recipient, the FMV should be
allocated among them, as appropriate.
If the beneficiary is the estate, enter the estate’s name
and TIN in place of the recipient’s on the form.
Distribution in year of death. If you learn of the
account holder’s death and make a distribution to the
beneficiary in the year of death, issue a Form 1099-SA
and enter in:
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• Box 1, the gross distribution;
• Box 3, code 4 (see Box 3. Distribution Code, later); and
• Box 4, the FMV of the account on the date of death.

Distribution after year of death. If you learn of the
death of the account holder and make a distribution after
the year of death, issue a Form 1099-SA in the year you
learned of the death of the account holder. Enter in:
• Box 1, the gross distribution;
• 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
decedent’s qualified medical expenses, if paid within 1
year after death.

HSAs. When the account holder dies, the following
applies.
• If the designated beneficiary is the surviving spouse,
the spouse becomes the account holder of the HSA.
• If the designated beneficiary is not the surviving
spouse, the account ceases to be an HSA on the date of
the account holder’s death. The FMV of the account as of
the date of death is required to be reported in box 4.
Follow the rules and coding above under Distribution in
year of death and Distribution after year of death.

Statements to Recipients

If you are required to file Form 1099-SA, you must provide
a statement to the recipient. For more information about
the requirement to furnish a Form 1099-SA or acceptable
substitute statement to recipients, see part M in the
current Pub. 1099.

Truncating Recipient’s TIN on Payee Statements
Pursuant to Regulations section 301.6109-4, all filers of
this form may truncate a recipient’s TIN (social security
number (SSN), individual taxpayer identification number
(ITIN), adoption taxpayer identification number (ATIN), or
employer identification number (EIN)) on payee
statements. Truncation is not allowed on any documents
the filer files with the IRS. A trustee’s/payer’s TIN may not
be truncated on any form. See part J in the current
Pub.1099.

For Calendar Year

Enter the 4-digit calendar year in the "For calendar year"
entry space for the calendar year this form is being filed.

Account Number

The account number is required if you have multiple
accounts for a recipient for whom you are filing more than
one Form 1099-SA. Additionally, the IRS encourages you
to designate an account number for all Forms 1099-SA
that you file. See part L in the current Pub. 1099.

Box 1. Gross Distribution

Enter the total amount of the distribution. Include any
earnings separately reported in box 2. You are not
required to determine the taxable amount of a distribution.
Do not report the following in box 1.
Instructions for Forms 1099-SA and 5498-SA (Rev. 12-2026)

• A negative amount.
• The withdrawal of excess employer contributions (and

the earnings on them) returned to an employer as a
distribution from an employee’s HSA.
• Excess MA MSA contributions returned to the Secretary
of Health and Human Services or their representative.

Box 2. Earnings on Excess Contributions

Enter the total earnings distributed with any excess HSA
or Archer MSA contributions returned by the due date of
the account holder’s tax return. Include this amount in
box 1. Report earnings on other distributions only in box 1.

Tip: For HSAs and Archer MSAs, if you are reporting
earnings on a distribution of excess contributions, use the
method under Regulations section 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.

Box 3. Distribution Code

Enter the appropriate distribution code from the following
list that shows the type of distribution.

Distribution Codes for Distributions From HSAs, Archer MSAs, and Medicare Advantage MSAs

1—Normal distributions

Use this code for normal distributions to the account
holder and any direct payments to a medical service
provider. Use this code if no other code applies. Also, see
Distribution after year of death, earlier.

2—Excess contributions

Use this code for distributions of excess HSA or Archer
MSA contributions to the account holder.

3—Disability

Use this code if you made distributions after the account
holder was disabled (see section 72(m)(7)).

4—Death distribution other than code 6

Use this code for payments to a decedent’s estate in the
year of death. Also use this code for payments to an
estate after the year of death. Don’t use with code 6. See
Death of Account Holder, earlier.

5—Prohibited transaction

See sections 220(e)(2) and 223(e)(2).

6—Death distribution after year of death to a nonspouse
beneficiary

Use this code for payments to a decedent’s nonspouse
beneficiary, other than an estate, after the year of death.
Don’t use with code 4.

Box 4. FMV on Date of Death

Enter the FMV of the account on the date of death. See
Death of Account Holder, earlier.

Box 5. Checkbox

Check the box to indicate if this distribution was from an
HSA, Archer MSA, or MA MSA.

Specific Instructions for Form
5498-SA

Note. The calendar year is the year that is entered on the
top right of this form for the year the information is being
reported. The subsequent year is the next year.
File Form 5498-SA, HSA, Archer MSA, or Medicare
Advantage MSA Information, with the IRS on or before
May 31 of the subsequent year for each person for whom
you maintained a health savings account (HSA), Archer
medical savings account (Archer MSA), or Medicare
Advantage MSA (MA MSA) during the calendar year. If
May 31 falls on a Saturday, Sunday, or a legal holiday, you
must file by the next day that is not a Saturday, Sunday, or
a legal holiday. You are required to file if you are the
trustee or custodian of an HSA, Archer MSA, or MA MSA.
A separate form is required for each type of plan.
For HSA or Archer MSA contributions made between
January 1 and April 15 of the subsequent year you should
Instructions for Forms 1099-SA and 5498-SA (Rev. 12-2026)

obtain the participant’s designation of the year for which
the contributions are made.
For repayment of a mistaken distribution amount, see
HSA Mistaken Distributions, earlier. Do not treat the
repayment as a contribution on Form 5498-SA.

Rollovers

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.

Transfers

Do not report a trustee-to-trustee transfer from one Archer
MSA or MA MSA to another Archer MSA or MA MSA,
from an Archer MSA to an HSA, or from one HSA to
another HSA. For reporting purposes, contributions and
rollovers do not include these transfers. However, see Box
2, later, for the reporting of a trustee-to-trustee transfer
from an IRA to an HSA.

Total Distribution, No Contributions

Generally, if a total distribution was made from an HSA or
Archer MSA during the year and no contributions were
made for that year, you need not file Form 5498-SA nor
furnish a statement to the participant to reflect that the fair
market value (FMV) on December 31 was zero.

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Death of Account Holder

In the year an HSA, Archer MSA, or MA MSA owner dies,
you must generally file a Form 5498-SA and furnish a
statement for the decedent. If the designated beneficiary
is the surviving spouse, the following apply.
• The spouse becomes the account holder of the HSA or
Archer MSA.
• An MA MSA is treated as an Archer MSA of the spouse
for distribution purposes, but no new contributions may be
made to the account.
If the designated beneficiary is not the spouse or there
is no designated beneficiary, the account ceases to be an
HSA, Archer MSA, or MA MSA.

Statements to Participants

If you are required to file Form 5498-SA, you must provide
a statement to the participant (generally Copy B) by May
31 of the subsequent year. If May 31 falls on a Saturday,
Sunday, or a legal holiday, you must provide the statement
by the next day that is not a Saturday, Sunday, or a legal
holiday. You may, but you are not required to, provide the
participant with a statement of the December 31 FMV of
the participant’s account by January 31 of the subsequent
year. For more information about statements to
participants, see part M in the current Pub. 1099.
If you furnished a statement of the FMV of the account
to the participant by January 31 of the subsequent year,
and no reportable contributions, including rollovers, were
made for the calendar year, you need not furnish another
statement (or Form 5498-SA) to the participant to report
zero contributions. However, you must file Form 5498-SA
with the IRS by May 31 of the subsequent year to report
the December 31 FMV of the account. If May 31 falls on a
Saturday, Sunday, or a legal holiday, you must file by the
next day that is not a Saturday, Sunday, or a legal holiday.
Caution: If you do not furnish another statement to the
participant because no reportable contributions were
made for the year, the statement of the FMV of the
account must contain a legend designating which
information is being furnished to the IRS.

Truncating Participant’s TIN on Payee
Statements

Pursuant to Regulations section 301.6109-4, all filers of
this form may truncate a participant’s TIN (social security
number (SSN), individual taxpayer identification number
(ITIN), adoption taxpayer identification number (ATIN), or
employer identification number (EIN)) on payee
statements. Truncation is not allowed on any documents
the filer files with the IRS. A trustee’s TIN may not be
truncated on any form. See part J in the current Pub.
1099.

For Calendar Year

Enter the 4-digit calendar year in the "For calendar year"
entry space for the calendar year this form is being filed.

Account Number

The account number is required if you have multiple
accounts for a recipient for whom you are filing more than
one Form 5498-SA. Additionally, the IRS encourages you
to designate an account number for all Forms 5498-SA
that you file. See part L in the current Pub. 1099.

Box 1. Employee or Self-Employed Person’s
Archer MSA Contributions Made in the Calendar
Year and the Subsequent Year for the Calendar
Year
Enter the employee’s or self-employed person’s regular
contributions to the Archer MSA made in the calendar
year and through the April 15 of the subsequent year, for
the calendar year. Report gross contributions, including
any excess contributions, even if the excess contributions
were withdrawn. No HSA information is to be reported in
box 1.

Box 2. Total Contributions Made in the Calendar
Year

Enter the total HSA or Archer MSA contributions made in
the calendar year. Include any contribution made in the
calendar year for the prior year . Also include qualified
HSA funding distributions (trustee-to-trustee transfers
from an IRA to an HSA under section 408(d)(9)) received
by you during the calendar year. Any excess employer
contributions (and the earnings on them) withdrawn by the
employer pursuant to Notice 2008-59, Q&A 24, available
at IRS.gov/irb/2008-29_IRB#NOT-2008-59, should not be
reported as a contribution. You may, but you are not
required to, report the total MA MSA contributions made in
the calendar year by the Secretary of Health and Human
Services or their representative. Do not include amounts
reported in box 4.

Box 3. Total HSA or Archer MSA Contributions
Made in the Subsequent Year for the Calendar
Year

Enter the total HSA or Archer MSA contributions made in
the subsequent year for the calendar year.

Box 4. Rollover Contributions

Enter rollover contributions to the HSA or Archer MSA
received by you during the calendar year. These amounts
are not to be included in box 2.

Box 5. Fair Market Value of HSA, Archer MSA, or
MA MSA

Enter the FMV of the account on December 31 of the
calendar year.

Box 6. Checkbox

Check the box to indicate if this account is an HSA, Archer
MSA, or MA MSA.

Country

For a list of country codes, go to IRS.gov/CountryCodes.

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Instructions for Forms 1099-SA and 5498-SA (Rev. 12-2026)