Header
The name or names shown on the return and the Social Security number of the MSA account holder. Page 2 asks for the policyholder's name and Social Security number.
8853
Archer MSAs and Long-Term Care Insurance Contracts
- Agency
- IRS
- Revision
- 2025
- Fillable fields
- 38
- Pages
- 2
- Official source
- IRS form page
- Checked
- October 21, 2026
Form 8853 (2025): Archer MSAs and Long-Term Care Insurance Contracts
Form 8853, Archer MSAs and Long-Term Care Insurance Contracts, is attached to Form 1040, 1040-SR or 1040-NR. This is the 2025 form. The IRS lists five uses: report Archer MSA contributions (including employer contributions), figure the Archer MSA deduction, report distributions from Archer MSAs or Medicare Advantage MSAs, report taxable payments from long-term care (LTC) insurance contracts, and report taxable accelerated death benefits from a life insurance policy.
The form has three sections. Section A covers Archer MSAs, Section B covers Medicare Advantage MSA distributions, and Section C on page 2 covers LTC insurance contracts and accelerated death benefits. The instructions say that after December 31, 2007, contributions can't be made to an Archer MSA except for certain active participants.
You can fill out Form 8853 free in your browser on this page and download the result without an account.
What's on Form 8853
Section A, Part I: contributions and deductions
Lines 1 to 5 cover employer contributions, the account holder's own contributions, the limitation from the instructions' worksheet, compensation, and the Archer MSA deduction.
Section A, Part II: distributions
Lines 6a to 9b cover total Archer MSA distributions, rollovers and withdrawn excess contributions, unreimbursed qualified medical expenses, the taxable amount and the additional 20% tax.
Section B: Medicare Advantage MSA distributions
Lines 10 to 13b cover total distributions, unreimbursed qualified medical expenses, the taxable amount and the additional 50% tax.
Section C: long-term care insurance contracts
Page 2, lines 14a to 26: the insured, two yes or no questions, per diem LTC payments and accelerated death benefits, the per diem limitation, and taxable payments.
How to fill out Form 8853
- 1
Name and SSN
Enter the name and SSN as shown on the return. The instructions say that if both spouses each have an Archer MSA or each have a Medicare Advantage MSA, enter the SSN shown first on the return.
- 2
Part I, lines 1 to 5
Line 1 is employer contributions, which the instructions say should appear in box 12 of Form W-2 with code R. Line 2 is the holder's own contributions for 2025. Line 5 is the smallest of lines 2, 3 and 4, also entered on Schedule 1 (Form 1040), line 23.
- 3
Part II, lines 6a to 8
Line 6a is total Archer MSA distributions, which the instructions say should be in box 1 of Form 1099-SA. Subtract rollovers and withdrawn excess contributions, then unreimbursed qualified medical expenses. Line 8 also goes on Schedule 1 (Form 1040), line 8e.
- 4
Lines 9a and 9b
The instructions say the additional 20% tax does not apply to distributions made after the account holder dies, becomes disabled or turns age 65. Check 9a if an exception applies, and enter 20% of the rest on 9b and on Schedule 2 (Form 1040), line 17e.
- 5
Section B, lines 10 to 13b
Enter Medicare Advantage MSA distributions from box 1 of Form 1099-SA and the amount used only for the account holder's qualified medical expenses. The 50% tax exceptions are death and disability, and the instructions have a worksheet for line 13b.
- 6
Section C, lines 14a to 26
Enter the insured's name and SSN and answer lines 15 and 16. Line 17 totals box 1 of the Forms 1099-LTC with the Per diem box checked. Line 21 is $420 times the days in the LTC period. Line 26 is the taxable amount.
Why fill Form 8853 on indox
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Where it goes and related forms
Attach to the return
The form says to attach it to Form 1040, 1040-SR or 1040-NR. It is not filed on its own.
Distributions without other income
The instructions say a person who received Archer MSA or Medicare Advantage MSA distributions in 2025 files Form 8853 with the return even with no taxable income or other reason to file.
Where the amounts go
The deduction goes on Schedule 1 (Form 1040), line 23. Taxable distributions and LTC payments go in the total on Schedule 1, line 8e. The additional taxes go on Schedule 2 (Form 1040), lines 17e and 17f.
Excess contributions
The instructions point to Form 5329 to figure the additional tax on excess contributions, and explain when excess contributions withdrawn by the due date, including extensions, are treated as not contributed.
Statement copies
Where the instructions call for separate statement Forms 8853, write "statement" across the top of each and attach them to the paper return after the controlling Form 8853.
Related forms
1099-SA
Distributions From an HSA, Archer MSA, or Medicare Advantage MSA
33 fields, 3 pages
1099-LTC
Long-Term Care and Accelerated Death Benefits
64 fields, 5 pages
5329
Additional Taxes on Qualified Plans (Including IRAs) and Other Tax-Favored Accounts
75 fields, 3 pages
1040
Additional Income and Adjustments to Income
73 fields, 2 pages
1040
U.S. Individual Income Tax Return
199 fields, 2 pages
1040-NR
U.S. Nonresident Alien Income Tax Return
171 fields, 2 pages
Who files Form 8853?
The instructions list the cases in which Form 8853 is filed. Each one involves an individual return: Form 1040, 1040-SR or 1040-NR.
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Questions about Form 8853
Who files Form 8853?
The instructions list people with Archer MSA contributions for 2025, people who received Archer MSA or Medicare Advantage MSA distributions, beneficiaries of a deceased account holder's MSA, and LTC policyholders who received per diem or periodic payments.
Is Form 8853 filed if a distribution was used only for medical expenses?
The instructions say anyone who received Archer MSA or Medicare Advantage MSA distributions in 2025 files Form 8853 with the return, even with no taxable income or other reason to file.
What is the additional tax on Archer MSA distributions?
Line 9b applies 20% (0.20) to taxable distributions. The instructions say it does not apply to distributions made after the account holder dies, becomes disabled or turns age 65.
What is the additional tax on Medicare Advantage MSA distributions?
Line 13b applies 50% (0.50). The instructions say it does not apply to distributions made on or after the date the account holder dies or becomes disabled.
Can contributions still be made to an Archer MSA?
The instructions say that after December 31, 2007, contributions can't be made unless the person was an active participant for a tax year ending before January 1, 2008, or became one through an HDHP of an Archer MSA participating employer.
What is the $420 on line 21?
The instructions call $420 the 2025 per diem limit for periodic payments received under a qualified LTC insurance contract, citing Rev. Proc. 2024-40, section 2.62.
Where do Form 1099-SA and Form 1099-LTC amounts go?
The instructions say Archer MSA and Medicare Advantage MSA distributions should be shown in box 1 of Form 1099-SA (lines 6a and 10). Per diem LTC payments come from box 1 of Form 1099-LTC (line 17) and accelerated death benefits generally from box 2 (line 19).