Instructions For Form 8853 - Archer Msas And Long-Term Care Insurance Contracts - 2005
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Department of the Treasury
Internal Revenue Service
Instructions for Form 8853
Archer MSAs and Long-Term Care Insurance Contracts
Advantage MSA, enter the SSN shown
Self-only
Family
General Instructions
coverage
coverage
first on your tax return.
Section references are to the Internal
Revenue Code unless otherwise noted.
Minimum annual
Section A—Archer MSAs
deductible
$1,750
$3,500
Purpose of Form
Maximum annual
Use Form 8853 to:
Eligible Individual
deductible
$2,650
$5,250
•
Report Archer MSA contributions
To be eligible for an Archer MSA, you (or
Maximum annual
(including employer contributions),
your spouse) must be an employee of a
out-of-pocket expenses
•
Figure your Archer MSA deduction,
small employer or be self-employed. You
(other than for premiums)
$3,500
$6,450
•
Report distributions from Archer MSAs
(or your spouse) must be covered under a
or Medicare Advantage MSAs,
high deductible health plan (HDHP) and
Other Health Coverage
•
Report taxable payments from
have no other health coverage except
If you have an Archer MSA, you (and your
long-term care (LTC) insurance contracts,
permitted coverage. You must not be
spouse, if you have family coverage)
or
enrolled in Medicare and cannot be
•
cannot have any health coverage other
Report taxable accelerated death
claimed as a dependent on someone
than an HDHP. But your spouse can have
benefits from a life insurance policy.
else’s 2005 tax return. You must be an
health coverage other than an HDHP if
eligible individual on the first day of a
Additional information. See Pub. 969,
you are not covered by that plan.
month to take an Archer MSA deduction
Health Savings Accounts and Other
Exceptions. You can have additional
Tax-Favored Health Plans, for more
for that month.
insurance that provides benefits only for:
details on MSAs.
•
Liabilities under workers’ compensation
Small Employer
laws, tort liabilities, or liabilities arising
Who Must File
A small employer is generally an
from the ownership or use of property,
•
employer who had an average of 50 or
You must file Form 8853 if any of the
A specific disease or illness, or
•
fewer employees during either of the last
following applies.
A fixed amount per day (or other
•
2 calendar years. See Pub. 969 for
You (or your employer) made
period) of hospitalization.
details.
contributions for 2005 to your Archer
You can also have coverage (either
MSA.
•
through insurance or otherwise) for
Archer MSA
You are filing a joint return and your
accidents, disability, dental care, vision
spouse (or his or her employer) made
Generally, an Archer MSA is a medical
care, or long-term care.
contributions for 2005 to your spouse’s
savings account set up exclusively for
Archer MSA.
paying the qualified medical expenses of
Disabled
•
You (or your spouse, if filing jointly)
the account holder or the account holder’s
An individual generally is considered
received Archer MSA or Medicare
spouse or dependent(s).
disabled if he or she is unable to engage
Advantage MSA distributions in 2005.
•
in any substantial gainful activity due to a
You acquired an interest in an Archer
Qualified Medical Expenses
physical or mental impairment which can
MSA or a Medicare Advantage MSA
Generally, qualified medical expenses for
be expected to result in death or to
because of the death of the account
Archer MSA purposes are unreimbursed
continue indefinitely.
holder. See Death of Account Holder that
medical expenses that could otherwise be
begins on this page.
Death of Account Holder
•
deducted on Schedule A (Form 1040).
You (or your spouse, if filing jointly)
See the Instructions for Schedule A and
If the account holder’s surviving spouse is
were a policyholder who received
Pub. 502, Medical and Dental Expenses
the designated beneficiary, the Archer
payments under an LTC insurance
(Including the Health Coverage Tax
MSA is treated as if the surviving spouse
contract or received any accelerated
Credit). However, you cannot treat
were the account holder. The surviving
death benefits from a life insurance policy
insurance premiums as qualified medical
spouse completes Form 8853 as though
on a per diem or other periodic basis in
expenses unless the premiums are for:
the Archer MSA belonged to him or her.
2005. See the instructions for Section C,
that begin on page 6.
•
If the designated beneficiary is not the
Long-term care (LTC) insurance,
•
account holder’s surviving spouse, or
Health care continuation coverage, or
there is no designated beneficiary, the
•
Health care coverage while receiving
Specific Instructions
account ceases to be an Archer MSA as
unemployment compensation under
of the date of death. The beneficiary
federal or state law.
Name and social security number
completes Form 8853 as follows.
•
(SSN). Enter your name(s) and SSN as
Enter “Death of Archer MSA account
High Deductible Health Plan
shown on your tax return. If filing jointly
holder” across the top of Form 8853.
•
An HDHP is a health plan that meets the
and both you and your spouse each have
Enter the name(s) shown on your tax
following requirements.
an Archer MSA or each have a Medicare
return and your SSN in the spaces
Cat. No. 24188L
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