Instructions For Form 8853 - Archer Msas And Long-Term Care Insurance Contracts - 2010
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82010
Department of the Treasury
Internal Revenue Service
Instructions for Form 8853
Archer MSAs and Long-Term Care Insurance Contracts
If you (or your spouse, if filing
dental expenses deduction, they do
Section references are to the Internal
!
jointly) received Archer MSA or
qualify, for tax years beginning before
Revenue Code unless otherwise noted.
Medicare Advantage MSA
January 1, 2011, as expenses for MSA
CAUTION
General Instructions
distributions in 2010, you must file Form
purposes. Qualified medical expenses are
8853 with a Form 1040 even if you have
those incurred by the account holder or
no taxable income or any other reason for
the account holder’s spouse or
After December 31, 2007,
!
filing Form 1040.
dependent(s). See the instructions for line
contributions cannot be made to
7 on page 4. However, you cannot treat
an Archer MSA for you, unless:
CAUTION
•
insurance premiums as qualified medical
You were an active Archer MSA
expenses unless the premiums are for:
participant for any tax year ending before
Specific Instructions
January 1, 2008, or
•
•
Long-term care (LTC) insurance,
You became an active Archer MSA
•
Name and social security number
Health care continuation coverage, or
participant for a tax year ending after
•
(SSN). Enter your name(s) and SSN as
Health care coverage while receiving
December 31, 2007, because of coverage
shown on your tax return. If filing jointly
unemployment compensation under
under a high deductible health plan of an
and both you and your spouse each have
federal or state law.
Archer MSA participating employer.
an Archer MSA or each have a Medicare
Purpose of Form
Advantage MSA, enter the SSN shown
High Deductible Health Plan
first on your tax return.
Use Form 8853 to:
An HDHP is a health plan that meets the
following requirements.
•
Section A—Archer MSAs
Report Archer MSA contributions
(including employer contributions),
Self-only
Family
•
coverage
coverage
Figure your Archer MSA deduction,
Eligible Individual
•
Report distributions from Archer MSAs
Minimum annual
or Medicare Advantage MSAs,
To be eligible for an Archer MSA, you (or
•
deductible
$2,000
$4,050
Report taxable payments from
your spouse) must be an employee of a
long-term care (LTC) insurance contracts,
small employer or be self-employed. You
Maximum annual
or
(or your spouse) must be covered under a
deductible
$3,000
$6,050
•
Report taxable accelerated death
high deductible health plan (HDHP) and
Maximum annual
benefits from a life insurance policy.
have no other health coverage except
out-of-pocket expenses
permitted coverage. You must not be
(other than for premiums)
$4,050
$7,400
enrolled in Medicare and cannot be
Additional information. See Pub. 969,
claimed as a dependent on someone
Health Savings Accounts and Other
else’s 2010 tax return. You must be an
Other Health Coverage
Tax-Favored Health Plans, for more
eligible individual on the first day of a
details on MSAs.
If you have an Archer MSA, you (and your
month to take an Archer MSA deduction
spouse, if you have family coverage)
for that month.
cannot have any health coverage other
Who Must File
than an HDHP. But your spouse can have
Small Employer
health coverage other than an HDHP if
You must file Form 8853 if any of the
you are not covered by that plan.
following applies.
A small employer is generally an
•
employer who had an average of 50 or
You (or your employer) made
Exceptions. You can have additional
fewer employees during either of the last
contributions for 2010 to your Archer
insurance that provides benefits only for:
2 calendar years. See Pub. 969 for
MSA.
•
Liabilities under workers’ compensation
•
details.
You are filing a joint return and your
laws, tort liabilities, or liabilities arising
spouse (or his or her employer) made
from the ownership or use of property,
contributions for 2010 to your spouse’s
Archer MSA
•
A specific disease or illness, or
Archer MSA.
•
Generally, an Archer MSA is a medical
A fixed amount per day (or other
•
You (or your spouse, if filing jointly)
savings account set up exclusively for
period) of hospitalization.
acquired an interest in an Archer MSA or
paying the qualified medical expenses of
a Medicare Advantage MSA because of
the account holder.
You can also have coverage (either
the death of the account holder. See
through insurance or otherwise) for
Death of Account Holder on page 2.
accidents, disability, dental care, vision
•
Qualified Medical Expenses
You (or your spouse, if filing jointly)
care, or long-term care.
were a policyholder who received
Generally, qualified medical expenses for
payments under an LTC insurance
Archer MSA purposes are unreimbursed
Disabled
contract or received any accelerated
medical expenses that could otherwise be
death benefits from a life insurance policy
deducted on Schedule A (Form 1040).
An individual generally is considered
on a per diem or other periodic basis in
See the Instructions for Schedule A and
disabled if he or she is unable to engage
2010. See the instructions for Section C
Pub. 502, Medical and Dental Expenses
in any substantial gainful activity due to a
that begin on page 5.
(Including the Health Coverage Tax
physical or mental impairment which can
•
You (or your spouse, if filing jointly)
Credit). However, even though
be expected to result in death or to
received Archer MSA or Medicare
non-prescription medicines (other than
continue indefinitely.
Advantage MSA distributions in 2010.
insulin) do not qualify for the medical and
Cat. No. 24188L
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