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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