5498-SA

HSA, Archer MSA, or Medicare Advantage MSA Information

Agency
IRS
Revision
Rev. December 2026
Fillable fields
57
Pages
3
Official source
IRS form page
Checked
October 21, 2026
Fill 5498-SA online
Page 1 of form 5498-SA

Form 5498-SA: HSA, Archer MSA, or Medicare Advantage MSA Information

Form 5498-SA, HSA, Archer MSA, or Medicare Advantage MSA Information, reports contributions, rollover contributions and the fair market value of a health savings account (HSA), Archer medical savings account (Archer MSA) or Medicare Advantage MSA (MA MSA).

It is filed by the trustee or custodian of the account, not by the account holder. The About Form 5498-SA page says the trustee or custodian files it for each person for whom it maintained an HSA, Archer MSA or MA MSA, with a separate form for each type of plan. The participant receives Copy B, and the participant instructions on the form say not to attach it to the income tax return but to keep it for their records.

The instructions say to use the December 2026 revision to file and furnish 2026 information in early 2027. The trustee can fill out the PDF free in the browser on this page and download it without an account.

What's on Form 5498-SA

Trustee and participant

The trustee's and participant's names, addresses in separate entry boxes, the trustee's telephone number, both TINs, the calendar year and an account number.

Box 1: Archer MSA contributions

Contributions by the employee or self-employed person to an Archer MSA made in the calendar year and in the subsequent year for the calendar year.

Boxes 2 and 3: total contributions

Box 2 shows total contributions made in the calendar year, and box 3 total HSA or Archer MSA contributions made in the subsequent year for the calendar year. The form says boxes 2 and 3 are for IRS use only.

Box 4: rollover contributions

Rollover contributions received during the calendar year. The participant instructions say this amount is not included in box 1, 2 or 3.

Boxes 5 and 6: value and account type

The fair market value of the HSA, Archer MSA or MA MSA at the end of the calendar year, and checkboxes for the account type.

How to fill out Form 5498-SA

  1. 1

    Header

    Enter the 4-digit calendar year and the trustee's and participant's details. The instructions say an account number is required when a recipient has multiple accounts, and that the trustee's TIN may not be truncated on any form.

  2. 2

    Box 1

    Enter the regular Archer MSA contributions made in the calendar year and through April 15 of the subsequent year, for the calendar year. The instructions say to report gross contributions, including excess contributions, and no HSA information.

  3. 3

    Box 2

    Enter total HSA or Archer MSA contributions made in the calendar year, including contributions made in the year for the prior year and qualified HSA funding distributions from an IRA. The instructions say not to include box 4 amounts.

  4. 4

    Box 3

    Enter contributions made in the subsequent year for the calendar year. For contributions made between January 1 and April 15, the instructions say to obtain the participant's designation of the year they are for.

  5. 5

    Box 4

    Enter rollovers from one Archer MSA to another and from an Archer MSA or HSA to an HSA. The instructions say trustee-to-trustee transfers between these accounts are not reported.

  6. 6

    Boxes 5 and 6

    Enter the fair market value of the account on December 31 of the calendar year, then check the box for an HSA, Archer MSA or MA MSA.

Why fill Form 5498-SA on indox

You get the real form, filled in a browser tab, with nothing standing between you and the finished PDF.

  • Fill the form right in your browser, no software to install
  • Free to fill and free to download, with no account
  • The official blank straight from the IRS, not a copy someone retyped
  • Works on a phone, tablet or computer

Due dates, copies and e-filing

Due to the IRS

The instructions say the form is filed with the IRS on or before May 31 of the subsequent year. If May 31 falls on a Saturday, Sunday or legal holiday, the due date is the next day that is not one.

Statement to the participant

The instructions say the statement to the participant, generally Copy B, is provided by May 31 of the subsequent year. A statement of the December 31 value may also be provided by January 31, but is not required.

Copies and paper filing

Copy A is for the Internal Revenue Service Center and Copy B is for the participant. 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.

Mistaken distributions

The instructions say the repayment of a mistaken HSA distribution is not treated as a contribution on Form 5498-SA.

Related forms

Who files Form 5498-SA?

  • Trustees and custodians

    The instructions say a trustee or custodian of an HSA, Archer MSA or MA MSA files for each person for whom it maintained one of these accounts during the calendar year. The form asks for the trustee's name, address, telephone number and TIN.

  • Participants

    The participant receives Copy B. The participant instructions say the trustee submits this information to the IRS and the participant keeps the form instead of attaching it to the tax return.

  • One form per plan type

    The About page says a separate form is required for each type of plan. Box 6 shows whether the account is an HSA, an Archer MSA or an MA MSA.

  • Year of the owner's death

    The instructions say that in the year an account owner dies, the trustee generally files a Form 5498-SA and furnishes a statement for the decedent.

  • Total distribution, no contributions

    The instructions say that generally, if a total distribution was made from an HSA or Archer MSA and no contributions were made for that year, the form need not be filed to show a zero December 31 value.

The trustee or custodian of the HSA, Archer MSA or MA MSA files it with the IRS. The participant receives Copy B and does not file it.

Official sources and the blank

Do it all with indox

View all 123 tools

Questions about Form 5498-SA

Does the account holder file Form 5498-SA?

No. The trustee or custodian of the account files it with the IRS. The participant instructions on the form say not to attach it to the income tax return and to keep it for your records.

When is Form 5498-SA due?

The instructions say it is filed with the IRS by May 31 of the subsequent year, and the statement to the participant is generally provided by the same date.

Why does box 3 show contributions from the next year?

Box 3 shows HSA or Archer MSA contributions made in the subsequent year for the calendar year on the form, such as contributions made between January 1 and April 15.

Are trustee-to-trustee transfers reported?

The instructions say transfers between Archer MSAs, MA MSAs and HSAs are not reported. A qualified HSA funding distribution, a trustee-to-trustee transfer from an IRA to an HSA, is included in box 2.

Where are employer contributions shown?

The participant instructions say employer contributions to an Archer MSA are shown on Form W-2 in box 12 with code R, and employer contributions to an HSA in box 12 with code W.

Which revision should be used?

The instructions say to use the December 2026 revision to file and furnish 2026 information in early 2027, and to keep using it until a superseding revision is issued.