Instructions For Form 8853 - Archer Msas And Long-Term Care Insurance Contracts - 2002
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Department of the Treasury
Internal Revenue Service
Instructions for Form 8853
Archer MSAs and Long-Term Care Insurance Contracts
Section references are to the Internal Revenue Code unless otherwise noted.
High Deductible Health Plan
General Instructions
An HDHP is a health plan that meets the
following requirements.
Specific Instructions
Purpose of Form
Use Form 8853 to:
Name and Social Security Number
Self-only
Family
•
(SSN). Enter your name(s) and SSN as
coverage
coverage
Report Archer MSA contributions
shown on your tax return. If filing jointly
(including employer contributions);
•
and both you and your spouse each have
Figure your Archer MSA deduction;
Minimum annual
•
an Archer MSA or each have a
deductible
$1,650
$3,300
Report distributions from Archer MSAs
Medicare+Choice MSA, enter the SSN
or Medicare+Choice MSAs;
Maximum annual
•
shown first on your tax return.
Report taxable payments from
deductible
$2,500
$4,950
long-term care (LTC) insurance contracts;
Section A—Archer MSAs
Maximum annual
or
•
out-of-pocket expenses
Report taxable accelerated death
(other than for premiums)
$3,300
$6,050
Eligible Individual
benefits from a life insurance policy.
To be eligible for an Archer MSA, you
Additional information. See Pub. 969,
Other Health Insurance
Medical Savings Accounts (MSAs), for
must be an employee of a small employer
If you have an Archer MSA, you (and your
or be self-employed. You also must have
more details on MSAs.
spouse, if you have family coverage) may
a high deductible health plan (HDHP) and
Who Must File
not have any health insurance coverage
have no other health insurance coverage
other than an HDHP.
except permitted coverage. You must be
You must file Form 8853 if any of the
an eligible individual on the first day of a
Exception. You may have additional
following apply.
•
month to take an Archer MSA deduction
insurance that provides benefits only for:
You (or your employer) made
•
for that month.
Accidents,
contributions for 2002 to your Archer
•
Disability,
MSA.
Small Employer
•
•
Dental care,
You are filing a joint return and your
•
A small employer is generally an
Vision care,
spouse (or his or her employer) made
•
employer who had an average of 50 or
Long-term care,
contributions for 2002 to your spouse’s
•
fewer employees during either of the last
Liabilities under workers’ compensation
Archer MSA.
•
2 calendar years. See Pub. 969 for
laws, tort liabilities, or liabilities arising
You (or your spouse, if filing jointly)
details.
from the ownership or use of property,
received Archer MSA or
•
A specific disease or illness, or
Medicare+Choice MSA distributions in
Archer MSA
•
A fixed amount per day (or other
2002.
An Archer MSA is a medical savings
•
period) of hospitalization.
You acquired an interest in an Archer
account set up exclusively for paying the
MSA or a Medicare+Choice MSA
Disabled
qualified medical expenses of the account
because of the death of the account
holder or the account holder’s spouse or
An individual generally is considered
holder. See Death of Account Holder on
dependent(s) in conjunction with an
disabled if he or she is unable to engage
this page.
HDHP.
•
in any substantial gainful activity due to a
You (or your spouse, if filing jointly)
physical or mental impairment which can
were a policyholder who received
Qualified Medical Expenses
be expected to result in death or to
payments under an LTC insurance
Generally, qualified medical expenses for
continue indefinitely.
contract or received any accelerated
Archer MSA purposes are unreimbursed
death benefits from a life insurance policy
medical expenses that could otherwise be
Death of Account Holder
on a per diem or other periodic basis in
deducted on Schedule A (Form 1040).
If the account holder’s surviving spouse is
2002. See the instructions for Section C,
See the Schedule A (Form 1040)
the designated beneficiary, the Archer
beginning on page 5.
instructions and Pub. 502, Medical and
MSA is treated as if the surviving spouse
Dental Expenses. However, you may not
were the account holder. The surviving
treat insurance premiums as qualified
spouse completes Form 8853 as though
medical expenses unless the premiums
the Archer MSA belonged to him or her.
are for:
In all other cases, the account ceases to
•
Long-term care (LTC) insurance,
be an Archer MSA as of the date of
•
Health care continuation coverage, or
death. If you are the beneficiary, complete
•
Health care coverage while receiving
Form 8853 as follows.
•
unemployment compensation under
Write “Death of Archer MSA account
Federal or state law.
holder” across the top of Form 8853.
Cat. No. 24188L
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