2023

Instructions for Form 8889

Health Savings Accounts (HSAs)

Department of the Treasury

Internal Revenue Service

Section references are to the Internal Revenue Code unless 

otherwise noted.

Future Developments

For the latest information about developments related to 

Form 8889 and its instructions, such as legislation enacted 

after they were published, go to IRS.gov/Form8889.

What’s New

Notice 2023-37. Due to the end of the COVID-19 national 

emergency, Notice 2023-37, 2023-30 I.R.B. 359, available at 

IRS.gov/irb/2023-30_IRB#NOT-2023-37, modified Notice 

2020-15 and clarified the definition of preventive care for 

purposes of the safe harbor.

Expiration of special COVID-19 rules in Notice 

2020-15. Notice 2023-37 provides that the special rules 

under Notice 2020-15 for reimbursement of treatment and 

testing for COVID-19 under a high deductible health plan 

(HDHP) apply only for plan years ending on or before 

December 31, 2024. For more information, see the 

discussion of Notice 2020-15 under High Deductible Health 

Plan, later.

Preventive care safe harbor for COVID-19 testing 

under an HDHP ends. An HDHP may have a zero 

deductible for certain preventive care. Notice 2023-37 ends 

the application of the preventive care safe harbor to 

COVID-19 testing effective as of July 24, 2023. However, 

COVID-19 testing remains a qualified medical expense 

subject to the minimum deductible.

Telehealth and other remote care extended. The 

Consolidated Appropriations Act 2023 extends the availability 

of telehealth and other remote care for HSAs. In the case of 

plan years beginning in 2023 or 2024:

1. An eligible individual may have separate coverage for 

telehealth and other remote care in addition to an HDHP.

2. An HDHP may have no deductible (or a deductible 

below the minimum annual deductible) for telehealth and 

other remote care services.

Insulin products. The Inflation Reduction Act, enacted 

August 16, 2022, amended section 223 to provide that an 

HDHP may have a zero deductible for selected insulin 

products. The amendment applies to plan years beginning 

after 2022.

Q&As on certain qualified medical expenses. You can 

find answers to questions regarding whether certain costs 

related to nutrition, wellness, and general health are medical 

expenses that may be paid or reimbursed under an HSA at 

IRS.gov/Individuals/Frequently-asked-questions-aboutmedical-expenses-related-to-nutrition-wellness-and-generalhealth.

Ask your HSA trustee whether your HSA and trustee 

meet the requirements of section 223.

CAUTION

!

Ask your health insurance provider(s) whether your 

HDHP and any disregarded coverage meet the 

requirements of section 223.

Reminders

Personal protective equipment. Amounts paid for 

personal protective equipment (PPE), such as masks, hand 

sanitizer, and sanitizing wipes, for use by you, your spouse, 

or your dependent(s) to prevent the spread of COVID-19 are 

eligible medical expenses that may be paid or reimbursed 

from an HSA. See Announcement 2021-7 at IRS.gov/IRB/

2021-15_IRB#ANN-2021-7.

Cost of home testing for COVID-19. The cost to diagnose 

COVID-19 is an eligible medical expense for tax purposes, 

which means the cost of home testing for COVID-19 for you, 

your spouse, or your dependent(s) may be paid or 

reimbursed from an HSA. See IRS.gov/Newsroom/IRS-Costof-Home-Testing-for-COVID-19-Is-Eligible-Medical-ExpenseReimbursable-Under-FSAs-HSAs.

General Instructions

Purpose of Form

Use Form 8889 to:

• Report health savings account (HSA) contributions 

(including those made on your behalf and employer 

contributions),

• Figure your HSA deduction,

• Report distributions from HSAs, and

• Figure amounts you must include in income and additional 

tax you may owe if you fail to be an eligible individual.

Additional information. See Pub. 969, Health Savings 

Accounts and Other Tax-Favored Health Plans, for more 

details on HSAs. Also, see the Instructions for Form 1040 and 

the Instructions for Form 1040-NR.

Who Must File

You must file Form 8889 if any of the following applies.

• You (or someone on your behalf, including your employer) 

made contributions for 2023 to your HSA.

• You received HSA distributions in 2023.

• You must include certain amounts in income because you 

failed to be an eligible individual during the testing period.

• You acquired an interest in an HSA because of the death 

of the account beneficiary. See Death of Account Beneficiary, 

later.

If you (or your spouse, if filing jointly) received HSA 

distributions in 2023, you must file Form 8889 with 

Form 1040, Form 1040-SR, or Form 1040-NR, even if 

you have no taxable income or any other reason for filing 

Form 1040, Form 1040-SR, or Form 1040-NR.

CAUTION

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CAUTION

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Sep 29, 2023 Cat. No. 37971Y
Definitions

Eligible Individual

To be eligible to have contributions made to your HSA, you 

must be covered under a high deductible health plan (HDHP) 

and have no other health coverage except certain 

disregarded coverage. If you are an eligible individual, 

anyone can contribute to your HSA. However, you cannot be 

enrolled in Medicare or be another person's dependent. An 

individual does not fail to be treated as an eligible individual 

for any period merely because the individual receives 

hospital care or medical services under any law administered 

by the Secretary of Veterans Affairs for a service-connected 

disability. You will not fail to be considered an eligible 

individual because you receive benefits from a health plan 

under surprise billing laws. You must be, or be considered, an 

eligible individual on the first day of a month to take an HSA 

deduction for that month (see Last-month rule next).

Last-month rule. If you are an eligible individual on the first 

day of the last month of your tax year (December 1 for most 

taxpayers), you are considered to be an eligible individual for 

the entire year, so long as you remain an eligible individual 

during the testing period as discussed below.

Testing period. You must remain an eligible individual 

during the testing period in order to take advantage of the 

last-month rule. The testing period begins with the last month 

of your tax year and ends on the last day of the 12th month 

following that month (for example, December 1, 2023 – 

December 31, 2024). If you fail to remain an eligible 

individual during this period, other than because of death or 

becoming disabled, you will have to include in income the 

total contributions made that would not have been made 

except for the last-month rule. You include this amount in 

income in the year in which you fail to be an eligible 

individual. This amount is also subject to a 10% additional 

tax. (See Part III.)

Account Beneficiary

The account beneficiary is the individual on whose behalf the 

HSA was established.

HSA

Generally, an HSA is a health savings account set up 

exclusively for paying the qualified medical expenses of the 

account beneficiary or the account beneficiary's spouse or 

dependents.

Distributions From an HSA

Distributions from an HSA used exclusively to pay qualified 

medical expenses of the account beneficiary, spouse, or 

dependents are excludable from gross income. (See the 

Line 15 instructions for information on medical expenses of 

dependents not claimed on your return.) You can receive 

distributions from an HSA even if you are not currently eligible 

to have contributions made to the HSA. However, any part of 

a distribution not used to pay qualified medical expenses is 

includible in gross income and is subject to an additional 

20% tax unless an exception applies.

Qualified Medical Expenses

Generally, “qualified medical expenses” for HSA purposes 

are unreimbursed medical expenses that could otherwise be 

deducted on Schedule A (Form 1040). See the Instructions 

for Schedule A and Pub. 502, Medical and Dental Expenses. 

As the HSA account beneficiary, you can pay these expenses 

for medical care for yourself, your spouse, and your 

dependents. Even though nonprescription medicines (other 

than insulin) do not qualify for the medical and dental 

expenses deduction, they do qualify as expenses for HSA 

purposes. The cost of menstrual care products (tampons, 

pads, liners, cups, sponges, or other similar products) are 

also reimbursable for HSA purposes.

Amounts you pay for personal protective equipment, such 

as masks, hand sanitizer, and sanitizing wipes for you, your 

spouse, and your dependent(s) for the primary purpose of 

preventing the spread of COVID-19 are treated as medical 

expenses eligible to be reimbursed from an HSA.

The cost of home testing for COVID-19 for you, your 

spouse, or your dependent(s) is an eligible medical expense 

for tax purposes, which may be paid or reimbursed from an 

HSA.

You can find answers regarding whether certain costs 

related to nutrition, wellness, and general health are medical 

expenses that may be paid or reimbursed under an HSA at 

IRS.gov/Individuals/Frequently-asked-questions-aboutmedical-expenses-related-to-nutrition-wellness-and-generalhealth.

Expenses incurred before you establish your HSA are not 

qualified medical expenses. If, under the last-month rule, you 

are considered to be an eligible individual for the entire year 

for determining the contribution amount, only those expenses 

incurred after you actually establish your HSA are qualified 

medical expenses.

You cannot treat insurance premiums as qualified medical 

expenses unless the premiums are for:

1. Long-term care (LTC) insurance,

2. Health care continuation coverage (such as coverage 

under COBRA),

3. Health care coverage while receiving unemployment 

compensation under federal or state law, or

4. Medicare and other health care coverage if you were 

65 or older (other than premiums for a Medicare 

supplemental policy, such as Medigap).

Coverage under (2) and (3) can be for your spouse or 

a dependent meeting the requirement. For (4), if you, 

the account beneficiary, are under age 65, Medicare 

premiums for your spouse or dependents (who are age 65 or 

older) are generally not qualified medical expenses.

High Deductible Health Plan

An HDHP is a health plan that meets the following 

requirements.

TIP

-2- Instructions for Form 8889 (2023)
Self-only 

coverage Family coverage

Minimum annual deductible $1,500 $3,000

Maximum annual 

out-of-pocket expenses* $7,500 $15,000

* This limit does not apply to deductibles and expenses for out-of-network 

services if the plan uses a network of providers. Instead, only deductibles 

and out-of-pocket expenses (such as copayments and other amounts, but 

not premiums) for services within the network should be used to figure 

whether the limit is reached.

Notice 2020-15, available at IRS.gov/irb/

2020-14_IRB#NOT-2020-15, provides that an HDHP may 

pay for medical care services and items purchased related to 

testing for, and treatment of, COVID-19 before satisfying the 

applicable minimum deductible. Notice 2023-37, 2023-30 

I.R.B. 359, provides that these special rules under Notice 

2020-15 apply only for plan years ending on or before 

December 31, 2024. For more information, see Notice 

2023-37 at IRS.gov/irb/2023-30_IRB#NOT-2023-37.

A health plan that is otherwise an HDHP will not fail to be 

considered an HDHP because it provides benefits under 

surprise billing laws before satisfaction of the HDHP 

deductible.

Safe harbor for insulin. An HDHP may have a zero 

deductible for selected insulin products. For more details, see 

Pub. 969.

Safe harbor for preventive care. An HDHP may have a 

zero deductible for preventive care. For more details, see 

Pub. 969. Testing for COVID-19 is no longer considered 

preventive care under this safe harbor effective as of July 24, 

2023. See Notice 2023-37, 2023-30 I.R.B. 359, at 

IRS.gov/irb/2023-30_IRB#NOT-2023-37.

Safe harbor for telehealth. An HDHP may have a zero 

deductible for telehealth and other remote care services for 

plan years beginning in 2023 or 2024.

Certain coverage disregarded. An eligible individual may 

have:

1. Coverage for any benefit provided by permitted 

insurance, and

2. Coverage (whether through insurance or otherwise) for 

accidents, disability, dental care, vision care, or long-term 

care, or (in the case of plan years beginning in 2023 or 2024) 

telehealth and other remote care.

Permitted insurance. Permitted insurance means:

A. Insurance if substantially all of the coverage provided 

relates to:

1. Liabilities incurred under workers’ compensation laws,

2. Tort liabilities, and/or,

3. Liabilities relating to ownership or use of property;

B. Insurance for a specified disease or illness; and

C. Insurance paying a fixed amount per day (or other period) 

of hospitalization.

For information on prescription drug plans, see Pub. 969.

Disabled

An individual is generally considered disabled if the individual 

is unable to engage in any substantial gainful activity due to a 

physical or mental impairment that can be expected to result 

in death or to continue indefinitely.

Death of Account Beneficiary

If the account beneficiary's surviving spouse is the 

designated beneficiary, the HSA is treated as if the surviving 

spouse were the account beneficiary. The surviving spouse 

completes Form 8889 as though the HSA belonged to the 

surviving spouse.

If the designated beneficiary is not the account 

beneficiary's surviving spouse, or there is no designated 

beneficiary, the account ceases to be an HSA as of the date 

of death. The beneficiary completes Form 8889 as follows.

• Enter “Death of HSA account beneficiary” across the top of 

Form 8889.

• Enter the name(s) shown on the beneficiary's tax return 

and the beneficiary's SSN in the spaces provided at the top 

of the form and skip Part I.

• On Part II, line 14a, enter the fair market value of the HSA 

as of the date of death.

• On Part II, line 15, for a beneficiary other than the estate, 

enter qualified medical expenses incurred by the account 

beneficiary before the date of death that the beneficiary paid 

within 1 year after the date of death.

• Complete the rest of Part II.

If the account beneficiary's estate is the beneficiary, the 

value of the HSA as of the date of death is included on the 

account beneficiary's final income tax return. Complete Form 

8889 as described above, except you should complete Part I, 

if applicable.

The distribution is not subject to the additional 20% tax. 

Report any earnings on the account after the date of death as 

income on your tax return.

Note. If, during the tax year, you are the beneficiary of two or 

more HSAs or you are a beneficiary of an HSA and you have 

your own HSA, you must complete a separate Form 8889 for 

each HSA. Enter “statement” at the top of each Form 8889 

and complete the form as instructed. Next, complete a 

controlling Form 8889, combining the amounts shown on 

each of the statement Forms 8889. Attach the statements to 

your paper tax return after the controlling Form 8889.

Deemed Distributions From HSAs

The following situations result in deemed distributions from 

your HSA.

• You engaged in any transaction prohibited by section 4975 

with respect to any of your HSAs, at any time in 2023. Your 

account ceases to be an HSA as of January 1, 2023, and you 

must include the fair market value of all assets in the account 

as of January 1, 2023, on line 14a.

• You used any portion of any of your HSAs as security for a 

loan at any time in 2023. You must include the fair market 

value of the assets used as security for the loan as income on 

Schedule 1 (Form 1040), line 8f.

Instructions for Form 8889 (2023) -3-
Any deemed distribution will not be treated as used to pay 

qualified medical expenses. Generally, these distributions are 

subject to the additional 20% tax.

Rollovers

A rollover is a tax-free distribution (withdrawal) of assets from 

one HSA or Archer MSA that is reinvested in another HSA of 

the same account beneficiary. Generally, you must complete 

the rollover within 60 days after you received the distribution. 

An HSA can only receive one rollover contribution during a 

1-year period. See Pub. 590-A, Contributions to Individual 

Retirement Arrangements (IRAs), for more details and 

additional requirements regarding rollovers.

Note. If you instruct the trustee of your HSA to transfer funds 

directly to the trustee of another of your HSAs, the transfer is 

not considered a rollover. There is no limit on the number of 

these transfers. Do not include the amount transferred in 

income, deduct it as a contribution, or include it as a 

distribution on line 14a.

Specific Instructions

Name and social security number (SSN). Enter your 

name(s) as shown on your tax return and the SSN of the HSA 

account beneficiary. If married filing jointly and both you and 

your spouse have HSAs, complete a separate Form 8889 for 

each of you.

Part I—HSA Contributions and 

Deductions

Use Part I to figure:

• Your HSA deduction,

• Any excess contributions you made (or those made on 

your behalf), and

• Any excess contributions made by an employer (see 

Excess Employer Contributions, later).

Figuring Your HSA Deduction

The maximum amount that can be contributed to your HSA 

depends on the type of HDHP coverage you have. If you have 

self-only coverage, your maximum contribution is $3,850. If 

you have family coverage, your maximum contribution is 

$7,750.

Note. If you are age 55 or older at the end of your tax year, 

you can make an additional contribution of $1,000.

Your maximum contribution is reduced by any employer 

contributions to your HSA, any contributions made to your 

Archer MSA, and any qualified HSA funding distributions.

You can make deductible contributions to your HSA even if 

your employer made contributions. However, if you (or 

someone on your behalf) made contributions in addition to 

any employer contributions and qualified HSA funding 

distributions, you may have to pay an additional tax. See 

Excess Contributions You Make, later.

You cannot deduct any contributions for any month in 

which you were enrolled in Medicare. Also, you cannot 

deduct contributions if you are someone else's dependent for 

2023.

How To Complete Part I

If both you and your spouse have HSAs, complete lines 1 

through 13 as instructed on the form. However, if you, and 

your spouse if filing jointly, are both eligible individuals and 

either of you has an HDHP with family coverage, you both are 

treated as having only the family coverage plan. Disregard 

any plans with self-only coverage.

Complete a separate Form 8889 for each spouse. 

Combine the amounts on line 13 of both Forms 8889 and 

enter this amount on Schedule 1 (Form 1040), line 13. Be 

sure to attach both Forms 8889 to your paper tax return.

Line 1

If you were covered, or considered covered, by a self-only 

HDHP and a family HDHP at different times during the year, 

check the box for the plan that was in effect for a longer 

period. If you were covered by both a self-only HDHP and a 

family HDHP at the same time, you are treated as having 

family coverage during that period. If, on the first day of the 

last month of your tax year (December 1 for most taxpayers), 

you had family coverage, check the “family” box.

Line 2

Include on line 2 only those amounts you, or others on your 

behalf, contributed to your HSA for 2023. Also, include 

amounts contributed for 2023 made in 2024 by the 

unextended deadline for filing your 2023 federal income tax 

return, April 15, 2024. If you were serving in, or in support of, 

the U.S. Armed Forces in a designated combat zone or 

contingency operation, you may be able to file later. See Pub. 

3 for details. Thus, you may contribute to your 2023 HSA 

through April 15, 2024, or a later date if you served in a 

designated combat zone or contingency operation.

Do not include employer contributions (see line 9) or 

amounts rolled over from another HSA or Archer MSA. See 

Rollovers, earlier. Also, do not include any qualified HSA 

funding distributions (see line 10). Payroll contributions 

through a salary reduction agreement elected by an 

employee (a cafeteria plan) are treated as employer 

contributions and are not included on line 2.

Line 3

When figuring the amount to enter on line 3, apply the 

following rules.

1. Use the family coverage amount if you or your spouse 

had an HDHP with family coverage. Disregard any plan with 

self-only coverage.

2. If the last-month rule (see Last-month rule, earlier) 

applies, you are considered an eligible individual for the 

entire year. You are treated as having the same HDHP 

coverage for the entire year as you had on the first day of the 

last month of your tax year.

3. If you were, or were considered, an eligible individual 

for the entire year and you did not change your type of 

coverage, enter $3,850 for a self-only HDHP or $7,750 for a 

family HDHP on line 3. (See (6) in this list.)

4. If you were, or were considered, an eligible individual 

for the entire year and you changed your type of coverage 

during the year, enter on line 3 (see (6) in this list) the greater 

of:

a. The limitation shown on the last line of the Line 3 

Limitation Chart and Worksheet (in these instructions), or

-4- Instructions for Form 8889 (2023)
b. The maximum amount that can be contributed based 

on the type of HDHP coverage you had on the first day of the 

last month of your tax year.

If you had family coverage on the first day of the last 

month, you do not need to use the worksheet; enter 

$7,750 on line 3.

5. If you were not an eligible individual on the first day of 

the last month of your tax year, use the Line 3 Limitation 

Chart and Worksheet (in these instructions) to determine the 

amount to enter on line 3. (See (6) in this list.)

6. If, at the end of 2023, you were age 55 or older and 

unmarried or married with self-only HDHP coverage for the 

entire year, you can increase the amount determined in (3) or 

(4) by $1,000 (the additional contribution amount). The 

$1,000 additional contribution amount is not allocable among 

TIP

spouses, unlike the $7,750 family contribution discussed 

below. For the Line 3 Limitation Chart and Worksheet, the 

additional contribution amount is included for each month 

you are an eligible individual.

Note. If you are married and had family coverage at any time 

during the year, the additional contribution amount is figured 

on line 7 and is not included on line 3.

See Pub. 969 for more information.

If you must complete the Line 3 Limitation Chart and 

Worksheet (in these instructions), and your eligibility 

and coverage did not change from one month to the 

next, enter the same number you entered for the previous 

month.

TIP

Instructions for Form 8889 (2023) -5-
Line 3 Limitation Chart and Worksheet

Before you begin:

Start Here

Were you enrolled in Medicare for the month? Yes

Yes

No

No Were you an eligible individual (see Eligible 

Individual, earlier) on the rst day of the month 

(see the line 3 instructions, earlier)?

Enter $3,850 on the line below 

for the month. If you were age 

55 or older at the end of 2023, 

enter $4,850 for the month.

Family coverage

Enter $7,750 on the line below for 

the month. If, at the end of 2023, 

you were unmarried and age 55 or 

older, enter $8,750 for the month.

Self-only coverage

What type of coverage did your HDHP provide on the rst day of the month?

Amount from 

Month in 2023 chart above

January . . . . . . . . . . . . . . . . . $ 

√ See the instructions for line 3, earlier.

√ Go through this chart for each month of 2023.

√ Keep for your records.

Enter -0- on 

the line below 

for the month.

February . . . . . . . . . . . . . . . . . $ 

March . . . . . . . . . . . . . . . . . . $ 

April . . . . . . . . . . . . . . . . . . . $ 

May . . . . . . . . . . . . . . . . . . . $ 

June . . . . . . . . . . . . . . . . . . . $ 

July . . . . . . . . . . . . . . . . . . . $ 

August . . . . . . . . . . . . . . . . . . $ 

September . . . . . . . . . . . . . . . . $ 

October . . . . . . . . . . . . . . . . . $ 

November . . . . . . . . . . . . . . . . $ 

December . . . . . . . . . . . . . . . . $ 

Total for all months

Limitation. Divide the total by 12. 

Enter here and on line 3

 . . . . . . . . . . . . . $ 

 . . . . . . . . . . . . $ 

-6- Instructions for Form 8889 (2023)
Line 6

Spouses who have separate HSAs and had family coverage 

under an HDHP at any time during 2023, use the following 

rules to figure the amount on line 6.

• If you are treated as having family coverage for each 

month, divide the amount on line 5 equally between you and 

your spouse, unless you both agree on a different allocation 

(such as allocating nothing to one spouse). Enter your 

allocable share on line 6.

Example. In 2023, you are an eligible individual and have 

self-only HDHP coverage. In March, you marry and as of 

April 1, you have family HDHP coverage. Neither you nor your 

spouse qualify for the additional contribution amount. Your 

spouse has a separate HSA and is an eligible individual from 

April 1 to December 31, 2023. Because you and your spouse 

are considered to have family coverage on December 1, your 

contribution limit is $7,750 (the family coverage maximum). 

You and your spouse can divide this amount in any allocation 

to which you agree (such as allocating nothing to one 

spouse).

• If you are not treated as having family coverage for each 

month, use the following steps to determine the amount to 

enter on line 6.

Step 1. Refigure the contribution limit that would have 

been entered on line 5 if you had entered on line 3 the total of 

the worksheet amounts only for the months you were treated 

as having family coverage. When refiguring line 5, use the 

same amount you previously entered on line 4.

Step 2. Divide the refigured contribution limit from Step 1 

equally between you and your spouse, unless you both agree 

on a different allocation (such as allocating nothing to one 

spouse).

Step 3. Subtract the part of the contribution limit allocated 

to your spouse in Step 2 from the amount determined in Step 

1.

Step 4. Determine any other contribution limits that apply 

for the tax year and add that amount to the result in Step 3. 

Enter the total on line 6.

Example. In 2023, you are an eligible individual and have 

family HDHP coverage. In March, you divorce and change 

your coverage as of April 1 to self-only. Neither you nor your 

ex-spouse qualify for the additional contribution amount. Your 

ex-spouse continued to have family HDHP coverage and was 

an eligible individual for the entire year. The contribution limit 

for the 3 months you both were considered to have family 

coverage is $1,937.50 ($7,750 × 3 ÷ 12). You and your 

ex-spouse decide to divide the family coverage contribution 

in the following manner: 75% to your ex-spouse and 25% to 

you. Your contribution limit for 9 months of self-only coverage 

is $2,887.50 ($3,850 × 9 ÷ 12). This amount is not divided 

between you and your spouse.

Because you are covered under a self-only policy on 

December 1, you will show $3,850 on line 6 (the greater of 

either (a) $3,371.87 ($1,937.50 family coverage + $2,887.50 

self-only coverage – $1,453.13 spousal allocation) or (b) the 

maximum amount that can be contributed ($3,850 for 

self-only coverage)). Your ex-spouse would show $7,750 on 

line 6 (the greater of either (a) $7,265.62 ($1,937.50 family 

coverage for the 3 months prior to the divorce + $5,812.50 

family coverage maintained after the divorce – $484.38 

spousal allocation) or (b) the maximum amount that can be 

contributed ($7,750 for family coverage)).

Line 7

Additional Contribution Amount

If, at the end of 2023, you were age 55 or older and married, 

use the Additional Contribution Amount Worksheet (in these 

instructions) if both of the following apply.

1. You or your spouse had family coverage under an 

HDHP and were, or were considered to be, an eligible 

individual on the first day of the month.

2. You were not enrolled in Medicare for the month.

Enter the result on line 7.

If items (1) and (2) apply to all months during 2023, 

enter $1,000 on line 7.

Example. At the end of 2023, you were age 55 and 

married. You had family coverage under an HDHP from 

January 1 through June 30, 2023 (6 months). You were not 

enrolled in Medicare in 2023. You would enter an additional 

contribution amount of $500 on line 7 ($1,000 × 6 ÷ 12).

Line 9

Employer Contributions

Employer contributions (including employee payroll 

contributions through a cafeteria plan) include any amount an 

employer contributes to any HSA for you for 2023. Also, 

include contributions made by a health insurance plan on an 

employer's behalf. These contributions should be shown in 

box 12 of Form W-2 with code W. If either of the following 

apply, complete the Employer Contribution Worksheet.

• Employer contributions for 2022 are included in the 

amount reported in box 12 of Form W-2 with code W.

• Employer contributions for 2023 are made in 2024.

If your employer made excess contributions, you may have to 

report the excess as income. See Excess Employer 

Contributions, later.

Line 10

Qualified HSA funding distribution. A distribution from 

your traditional IRA or Roth IRA to your HSA in a direct 

trustee-to-trustee transfer is called an HSA funding 

distribution. Note that these funds are not being distributed 

from your HSA, but rather are being distributed from your IRA 

and contributed to your HSA. Enter this amount on line 10.

The qualified HSA funding distribution is not included in 

your income, is not deductible, and reduces the amount that 

can be contributed to your HSA by you and from other 

sources (including employer contributions). This distribution 

cannot be made from an ongoing SEP IRA or SIMPLE IRA. 

For this purpose, a SEP IRA or SIMPLE IRA is ongoing if an 

employer contribution is made for the plan year ending with 

or within your tax year in which the distribution would be 

made.

The maximum amount that can be excluded from income 

is based on your age at the end of the year and your HDHP 

coverage (self-only or family) at the time of the distribution. 

TIP

Additional Contribution Amount Worksheet

1. $1,000 × number of months eligible .........

2. Divide line 1 by 12. Enter here and on 

line 7 ................................

Instructions for Form 8889 (2023) -7-
You can make only one qualified HSA funding distribution 

during your lifetime. However, if you make the distribution 

during a month when you have self-only HDHP coverage, you 

can make another qualified HSA funding distribution in a later 

month in that tax year if you change to family HDHP 

coverage.

See the discussions under Line 13 for the treatment of 

excess contributions.

See Pub. 969 for more information.

Testing period. If you received a traditional IRA or Roth 

IRA distribution, you must remain an eligible individual during 

the testing period. The testing period begins with the month 

in which the traditional IRA or Roth IRA distribution is 

contributed to the HSA and ends on the last day of the 12th 

month following that month. For example, if the distribution is 

contributed on June 17, 2023, the testing period ends on 

June 30, 2024. If you fail to remain an eligible individual 

during this period, other than because of death or becoming 

disabled, you will have to include the qualified HSA funding 

distribution in income in the year in which you fail to be an 

eligible individual. This amount is also subject to a 10% 

additional tax. (See Part III.)

Line 13

If you or someone on your behalf (or your employer) 

contributed more to your HSA than is allowable, you may 

have to pay an additional tax on the excess contributions. 

Figure the excess contributions using the following 

instructions. See Form 5329, Additional Taxes on Qualified 

Plans (Including IRAs) and Other Tax-Favored Accounts, to 

figure the additional tax.

Excess Contributions You Make

To figure your excess contributions (including those made on 

your behalf), subtract your deductible contributions (line 13) 

from your actual contributions (line 2). However, you can 

withdraw some or all of your excess contributions for 2023 

and they will be treated as if they had not been contributed if:

• You make the withdrawal by the due date, including 

extensions, of your 2023 tax return (but see the Note under 

Excess Employer Contributions, later);

• You do not claim a deduction for the amount of the 

withdrawn contributions; and

• You also withdraw any income earned on the withdrawn 

contributions and include the earnings in “Other income” on 

your tax return for the year you withdraw the contributions 

and earnings.

Excess Employer Contributions

Excess employer contributions are the excess, if any, of your 

employer's contributions over your limitation on line 8. If you 

made a qualified HSA funding distribution (line 10) during the 

tax year, reduce your limitation (line 8) by that distribution 

before you determine whether you have excess employer 

contributions. If the excess was not included in income on 

Form W-2, you must report it as “Other income” on your tax 

return. However, you can withdraw some or all of the excess 

employer contributions for 2023 and they will be treated as if 

they had not been contributed if:

• You make the withdrawal by the due date, including 

extensions, of your 2023 tax return (but see the following 

Note);

• You do not claim an exclusion from income for the amount 

of the withdrawn contributions; and

• You also withdraw any income earned on the withdrawn 

contributions and include the earnings in “Other income” on 

your tax return for the year you withdraw the contributions 

and earnings.

Note. If you timely filed your return without withdrawing the 

excess contributions, you can still make the withdrawal no 

later than 6 months after the due date of your tax return, 

excluding extensions. If you do, file an amended return with 

“Filed pursuant to section 301.9100-2” written at the top. 

Include an explanation of the withdrawal. Make all necessary 

changes on the amended return (for example, if you reported 

the contributions as excess contributions on your original 

return, include an amended Form 5329 reflecting that the 

withdrawn contributions are no longer treated as having been 

contributed).

Deducting an Excess Contribution in a Later Year

You may be able to deduct excess contributions for previous 

years that are still in your HSA. The excess contributions you 

can deduct in the current year is the lesser of the following 

two amounts.

• Your maximum HSA contribution limit for the year minus 

any amounts contributed to your HSA for the year.

• The total excess contributions in your HSA at the 

beginning of the year.

Any excess contribution remaining at the end of the tax 

year is subject to the additional tax. See Form 5329.

Part II—HSA Distributions

Line 14a

Enter the total distributions you received in 2023 from all 

HSAs. Your total distributions include amounts paid with a 

debit card that restricts payments to health care and amounts 

withdrawn by other individuals that you have designated. 

These amounts should be shown in box 1 of Form 1099-SA.

Employer Contribution Worksheet Keep for Your Records

1. Enter the employer contributions reported in box 12 of Form W-2, with code W .......................... 1.

2. Enter employer contributions made in 2023 for tax year 2022 ........................................ 2.

3. Subtract line 2 from line 1 .................................................................... 3.

4. Enter employer contributions made in 2024 for tax year 2023 ........................................ 4.

5. Employer contributions for 2023. Add lines 3 and 4. Enter here and on Form 8889, line 9 ................ 5.

-8- Instructions for Form 8889 (2023)
Line 14b

Include on line 14b any distributions you received in 2023 

that qualified as a rollover contribution to another HSA. See 

Rollovers, earlier. Also include any excess contributions (and 

the earnings on those excess contributions) included on 

line 14a that were withdrawn by the due date, including 

extensions, of your return. See the instructions for line 13, 

earlier.

Line 15

Only include on line 15 distributions from your HSA 

that were used to pay you for qualified medical 

expenses (see Qualified Medical Expenses, earlier) 

not reimbursed by insurance or other coverage and that you 

incurred after the HSA was established. Do not include the 

distribution of an excess contribution taken out after the due 

date, including extensions, of your return even if used for 

qualified medical expenses.

In general, include on line 15 distributions from all HSAs in 

2023 that were used for the qualified medical expenses (see 

Qualified Medical Expenses, earlier) of:

1. You and your spouse.

2. All your dependents.

3. Any person who would be a dependent except that:

a. The person filed a joint return.

b. The person had gross income.

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 claim to 

the child as the custodial parent’s dependent.

You cannot take a deduction on Schedule A (Form 

1040) for any amount you include on line 15.

Lines 17a and 17b

Additional 20% Tax

HSA distributions included in income (line 16) are subject to 

an additional 20% tax unless one of the following exceptions 

applies.

Exceptions to the Additional 20% Tax

The additional 20% tax does not apply to distributions made 

after the account beneficiary:

• Dies,

• Becomes disabled (see Disabled, earlier), or

• Turns age 65.

CAUTION

!

TIP

CAUTION

!

If any of the exceptions apply to any of the distributions 

included on line 16, check the box on line 17a. Enter on 

line 17b only 20% (0.20) of any amount included on line 16 

that does not meet any of the exceptions.

Example 1. You turned age 63 in 2023 and received a 

distribution from an HSA that is included in income. Do not 

check the box on line 17a because you (the account 

beneficiary) did not meet the age exception for the 

distribution. Enter 20% of the amount from line 16 on 

line 17b.

Example 2. 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 17a because the 

additional 20% tax does not 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 17b, 20% of the amount 

of these distributions included on line 16.

Note. There may be very limited and unusual circumstances 

in which you may be able to return mistaken distributions 

such that the amount will not be subject to the additional tax. 

For more information, see Notice 2004-50, Q/A 37 and 76, at 

IRS.gov/IRB/2004-33_IRB#NOT-2004-50.

Part III—Income and Additional Tax 

for Failure To Maintain HDHP 

Coverage

Use Part III to figure any additional income and adjustments 

to income that must be reported on Schedule 1 (Form 1040) 

and additional taxes that must be reported on Schedule 2 

(Form 1040) for failure to be an eligible individual during the 

testing period for:

• Last-month rule (see Last-month rule, earlier), or

• A qualified HSA funding distribution (see the Instructions 

for line 10, earlier).

See the discussion, earlier, on determining the testing period 

for both the last-month rule and a qualified HSA funding 

distribution. Include the amount in income in the year in 

which you fail to be an eligible individual.

Line 18

You can use the Line 3 Limitation Chart and Worksheet (in 

these instructions) for the year the contribution was made to 

determine the contribution you could have made if the 

last-month rule did not apply. Enter on line 18 the excess of 

the amount contributed over the redetermined amount. 

Examples of this computation are in Pub. 969.

Line 19

Enter the total of any qualified HSA funding distribution (see 

line 10).

Instructions for Form 8889 (2023) -9-