Instructions For Form 8889 (2015) (Page 3 of 6) in pdf

Line 1

filing jointly and both you and your

If you had family coverage on

spouse have HSAs, complete a

the first day of the last month,

If you were covered, or considered

TIP

separate Form 8889 for each of you.

you do not need to use the

covered, by a self-only HDHP and a

worksheet; enter $6,650 on line 3.

family HDHP at different times during

Part I—HSA Contributions

the year, check the box for the plan that

5. If you were not an eligible

and Deductions

was in effect for a longer period. If you

individual on the first day of the last

were covered by both a self-only HDHP

Use Part I to figure:

month of your tax year, use the

Line 3

and a family HDHP at the same time,

Your HSA deduction,

Limitation Chart and

Worksheet, later to

you are treated as having family

Any excess contributions you made

determine the amount to enter on line 3.

coverage during that period. If, on the

(or those made on your behalf), and

(See (6) in this list.)

first day of the last month of your tax

Any excess contributions made by an

6. If, at the end of 2015, you were

year, December 1 for most taxpayers,

employer (see

Excess Employer

age 55 or older and unmarried or

you had family coverage, check the

Contributions, later).

married with self-only HDHP coverage

“family” box.

for the entire year, you can increase the

Figuring Your HSA Deduction

Line 2

amount determined in (3) or (4) by

The maximum amount that can be

$1,000 (the additional contribution

Include on line 2 only those amounts

contributed to your HSA depends on the

amount). For (5), the additional

you, or others on your behalf,

type of HDHP coverage you have. If you

contribution amount is taken into

contributed to your HSA in 2015. Also,

have self-only coverage, your maximum

account for each month you are an

include those contributions made from

contribution is $3,350. If you have family

eligible individual.

January 1, 2016, through April 18, 2016,

coverage, your maximum contribution is

that were for 2015. Do not include

$6,650.

Note. If you are married and had family

employer contributions (see line 9) or

coverage at any time during the year,

amounts rolled over from another HSA

Note. If you are age 55 or older at the

the additional contribution amount is

or Archer MSA. See Rollovers, earlier.

end of your tax year, you can make an

figured on line 7 and is not included on

Also, do not include any qualified HSA

additional contribution of $1,000.

line 3.

funding distributions (see line 10).

Your maximum contribution is

Contributions to an employee's account

See Pub. 969 for more information.

reduced by any employer contributions

through a cafeteria plan are treated as

If you must complete the

Line 3

to your HSA, any contributions made to

employer contributions and are not

Limitation Chart and

your Archer MSA, and any qualified

included on line 2.

TIP

Worksheet, and your eligibility

HSA funding distributions.

Line 3

and coverage did not change from one

month to the next, enter the same

You can make deductible

When figuring the amount to enter on

number you entered for the previous

contributions to your HSA even if your

line 3, apply the following rules.

month.

employer made contributions. However,

1. Use the family coverage amount

if you (or someone on your behalf)

if you or your spouse had an HDHP with

Line 6

made contributions in addition to any

family coverage. Disregard any plan

employer contributions and qualified

Spouses who have separate HSAs and

with self-only coverage.

HSA funding distributions, you may

had family coverage under an HDHP at

2. If the last-month rule (see

have to pay an additional tax. See

any time during 2015, use the following

Last-month

rule, earlier) applies, you

Excess Contributions You

Make, later.

rules to figure the amount on line 6.

are considered an eligible individual for

If you are treated as having family

the entire year. You are treated as

You cannot deduct any contributions

coverage for each month, divide the

having the same HDHP coverage for

for any month in which you were

amount on line 5 equally between you

the entire year as you had on the first

enrolled in Medicare. Also, you cannot

and your spouse, unless you both agree

day of the last month of your tax year.

deduct contributions if you can be

on a different allocation (such as

claimed as a dependent on someone

3. If you were, or were considered,

allocating nothing to one spouse). Enter

else's 2015 tax return.

an eligible individual for the entire year

your allocable share on line 6.

and you did not change your type of

How To Complete Part I

Example. In 2015, you are an

coverage, enter $3,350 for a self-only

eligible individual and have self-only

Complete lines 1 through 13 as

HDHP or $6,650 for a family HDHP on

HDHP coverage. In March you marry

instructed on the form. However, if you,

line 3. (See (6) in this list.)

and as of April 1 you have family HDHP

and your spouse if filing jointly, are both

4. If you were, or were considered,

coverage. Neither you nor your spouse

eligible individuals and either of you

an eligible individual for the entire year

qualify for the additional contribution

have an HDHP with family coverage,

and you changed your type of coverage

amount. Your spouse has a separate

you both are treated as having only the

during the year, enter on line 3 (see (6)

HSA and is an eligible individual from

family coverage plan. Disregard any

in this list) the greater of:

April 1 to December 31, 2015. Because

plans with self-only coverage.

a. The limitation shown on the last

you and your spouse are considered to

line of the

Line 3 Limitation Chart and

have family coverage on December 1,

Complete a separate Form 8889 for

Worksheet, later or

your contribution limit is $6,650 (the

each spouse. Combine the amounts on

family coverage maximum). You and

line 13 of both Forms 8889 and enter

b. The maximum amount that can

your spouse can divide this amount in

this amount on Form 1040, line 25; or

be contributed based on the type of

any allocation to which you agree (such

Form 1040NR, line 25. Be sure to attach

HDHP coverage you had on the first day

as allocating nothing to one spouse).

both Forms 8889 to your paper tax

of the last month of your tax year.

return.

Form 8889 (2015)

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Instructions For Form 8889 (2015) Page 3

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