1099-SA

Distributions From an HSA, Archer MSA, or Medicare Advantage MSA

Agency
IRS
Revision
Rev. April 2025
Fillable fields
33
Pages
3
Official source
IRS form page
Checked
October 21, 2026
Fill 1099-SA online
Page 1 of form 1099-SA

Form 1099-SA: Distributions From an HSA, Archer MSA, or Medicare Advantage MSA

Form 1099-SA, Distributions From an HSA, Archer MSA, or Medicare Advantage MSA, is an information return. The IRS page says it reports distributions made from a health savings account (HSA), an Archer Medical Savings Account (Archer MSA) or a Medicare Advantage Medical Savings Account (MA MSA). The distribution may have been paid directly to a medical service provider or to the account holder, and a separate return is filed for each plan type.

The trustee or payer of the account completes the form. Copy A is for the IRS and Copy B goes to the recipient. The Instructions for Recipient on Copy B say Form 8853 or Form 8889 is filed with Form 1040 or 1040-SR to report a distribution from these accounts even if it isn't taxable, and that the payer isn't required to compute the taxable amount.

The instructions say Forms 1099-SA and 5498-SA have been converted to an online fillable format because the IRS receives very few paper copies. You can fill out the PDF free in your browser on this page and download it without an account.

What's on Form 1099-SA

Trustee, payer and recipient boxes

The trustee's or payer's name, address and telephone number, the payer's TIN, the recipient's TIN, name and address, and an account number.

Box 1: Gross distribution

The total amount distributed in the year, including any earnings separately reported in box 2.

Box 2: Earnings on excess contributions

The earnings distributed with excess HSA or Archer MSA contributions returned by the due date of the account holder's tax return.

Box 3: Distribution code

One code: 1 normal distribution, 2 excess contributions, 3 disability, 4 death distribution other than code 6, 5 prohibited transaction, 6 death distribution after year of death to a nonspouse beneficiary.

Box 4: FMV on date of death

If the account holder died, the fair market value of the account on the date of death.

Box 5: Account type

Three checkboxes, HSA, Archer MSA and MA MSA, showing the type of account reported on the form.

How to fill out Form 1099-SA

  1. 1

    Calendar year and account number

    Enter the 4-digit calendar year. The instructions say an account number is required when a recipient has multiple accounts with more than one Form 1099-SA, and the IRS encourages one on every form.

  2. 2

    Box 1

    Enter the total distribution, including any box 2 earnings. The instructions say not to enter a negative amount, excess employer contributions returned to an employer, or excess MA MSA contributions returned to the Secretary of Health and Human Services.

  3. 3

    Box 2

    Enter the earnings distributed with excess HSA or Archer MSA contributions. If box 2 includes such earnings, the instructions say to enter code 2 in box 3.

  4. 4

    Box 3

    Enter the code for the type of distribution. Code 1 covers normal distributions, direct payments to a medical service provider, and any distribution where no other code applies.

  5. 5

    Box 4 after a death

    Enter the FMV on the date of death. For a distribution after the year of death, the instructions say to reduce it by HSA payments for the decedent's qualified medical expenses paid within 1 year after death.

  6. 6

    Box 5

    Check the box for the type of account the distribution came from: HSA, Archer MSA or MA MSA.

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Copies, e-filing and statements

Copies

Copy A is for the Internal Revenue Service Center and Copy B is for the recipient. The instructions say a filer with few recipients filing on paper can send the black-and-white Copy A with a Form 1096 also printed from the IRS website.

E-filing

The instructions say the e-file threshold was lowered to 10 returns, counted across all information returns, for returns required to be filed on or after January 1, 2024. IRIS is the IRS online portal for e-filing information returns.

Statement to the recipient

A filer of Form 1099-SA provides a statement to the recipient. The instructions point to part M of Pub. 1099 for the rules on furnishing the form or an acceptable substitute.

When and where to file

These instructions print no due date for Form 1099-SA. They say to also use Pub. 1099, General Instructions for Certain Information Returns, which covers who must file and when and where to file.

Mistaken HSA distributions

If a trustee allows repayment of a mistaken distribution, the instructions say not to report it on Form 1099-SA and to correct any form already filed with the IRS and the account beneficiary.

Which revision to use

The instructions say to use the April 2025 revision of Form 1099-SA to file and furnish 2026 information in early 2027, and to keep using it until a superseding revision is issued.

Related forms

Who files Form 1099-SA?

  • HSA, Archer MSA and MA MSA trustees

    The trustee or payer named in the first box, with its address and telephone number, files the form and provides a statement to the recipient. The instructions address the trustee or custodian of the account.

  • Account holders

    The account holder receives Copy B for distributions paid to them or directly to a medical service provider during the year.

  • Beneficiaries after a death

    After the account holder dies, a spouse, an estate or another beneficiary can be the recipient. If the estate is the beneficiary, the instructions say to enter the estate's name and TIN in place of the recipient's.

  • One form per plan type

    The IRS page says a separate return is filed for each plan type. Box 5 shows whether the distribution came from an HSA, an Archer MSA or an MA MSA.

  • Not for trustee-to-trustee transfers

    The instructions say not to report a transfer from one HSA to another HSA, from one Archer MSA or MA MSA to another, or from an Archer MSA to an HSA.

The trustee or payer named in the form's first box completes and files it. The account holder or beneficiary receives Copy B and does not file it with the IRS.

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Questions about Form 1099-SA

Who files Form 1099-SA?

The trustee or payer of the HSA, Archer MSA or MA MSA that made the distribution. Its name goes in the first box of the form, and the recipient gets Copy B.

Is a distribution reported even if it is not taxable?

The Instructions for Recipient say Form 8853 or Form 8889 is filed with Form 1040 or 1040-SR to report a distribution from these accounts even if the distribution isn't taxable.

Does the payer figure the taxable amount?

No. The form says the payer isn't required to compute the taxable amount of any distribution, and the instructions say the same for box 1.

What do the box 3 codes mean?

1 is a normal distribution, 2 excess contributions, 3 disability, 4 a death distribution other than code 6, 5 a prohibited transaction, and 6 a death distribution after the year of death to a nonspouse beneficiary.

Is a transfer from one HSA to another reported?

No. The instructions say not to report a trustee-to-trustee transfer from one HSA to another HSA.

Which form reports HSA contributions?

Form 5498-SA, HSA, Archer MSA, or Medicare Advantage MSA Information. It shares the same instructions as Form 1099-SA.