How to fill out Form 8889 (HSA), line by line

• Who files Form 8889 and what to gather first

• Part I: choose your coverage and report personal HSA contributions

• Part II: calculate your contribution limit and HSA deduction (lines 3–13)

• Part III: report HSA distributions and calculate taxable amounts (lines 14a–17b)

• Part IV: when the last-month rule or IRA-to-HSA transfer creates income and a 10% tax

• Special situations and official next steps

Who files Form 8889 and what to gather first

You must file Form 8889 if you, an employer, or someone else made HSA contributions for you; your HSA made a distribution; you failed a testing period and must recognize income; or you acquired an HSA interest after the account beneficiary died. If you or your spouse received an HSA distribution in 2025, attach the form to Form 1040, 1040-SR, or 1040-NR even if you otherwise have no taxable income or filing requirement.

Enter the name or names shown on the tax return, but use the HSA account beneficiary’s Social Security number. Joint filers who each have separate HSAs generally complete separate applicable parts or forms for each spouse. Before starting, collect contribution records, Form W-2 box 12 code W if applicable, Form 1099-SA, and records of unreimbursed qualified medical expenses. Complete Form 8853 first when it is required, because its Archer MSA amounts feed Form 8889 line 4.

• Part I, lines 1–13: contribution limit and HSA deduction.

• Part II, lines 14a–17b: distributions, qualified expenses, taxable income, and any 20% additional tax.

• Part III, lines 18–21: income and a separate 10% additional tax after a failed last-month-rule or qualified-funding-distribution testing period.

• government form instructions

Part I: choose your coverage and report personal HSA contributions

Line 1: Self-only or family HDHP coverage

Line 1 is a 2025 coverage classification, not simply the plan you have now. If you had self-only and family HDHP coverage at different times, check the plan in effect for the longer period. If both applied at the same time, treat that period as family coverage. If you and your spouse are treated as covered by a family HDHP, each is treated as having family coverage. If family coverage was in effect on the first day of the last month of the tax year, check family. This choice helps set the line 3 limitation route; it does not by itself settle every line 3 worksheet question.

Line 2: Contributions you made for 2025

Enter contributions you made for 2025, or that someone else made on your behalf. This can include a contribution made in 2026 for 2025 if it is made by the unextended filing deadline, April 15, 2026. A later deadline may apply for qualifying service in, or support of, a designated combat zone or contingency operation; the IRS directs those readers to Pub. 3.

Part II: calculate your contribution limit and HSA deduction (lines 3–13)

Line 3: when the annual amount applies and when to use the monthly worksheet

Line 3 starts the contribution-limit calculation. For a person under age 55 at year-end who was, or was considered, an eligible individual on the first day of every month and had the same coverage all year, the 2025 amount is $4,300 for self-only coverage or $8,550 for family coverage. The family amount applies if you or your spouse had family HDHP coverage; disregard self-only coverage for that determination.

Ordinary 2025 line 3 amounts

Lines 4–8: adjustments, spouses, and age-55 amount

Line 4 reduces HSA capacity for Archer MSA contributions: use Form 8853, Section A, Part I, lines 1 and 2. If you or your spouse had family HDHP coverage at any point in 2025, include the spouse’s Archer MSA contributions too. Line 5 is line 3 minus line 4, with zero entered if the result is zero or less.

Line 6 normally carries line 5. But spouses with separate HSAs and family coverage must allocate the limit. If both are treated as family-covered for every month, they divide line 5 equally unless they agree to another allocation. If family coverage did not apply for every month, use the instructions’ four-step line 6 procedure rather than guessing. Line 7 is the additional contribution amount for a married person age 55 or older under the stated family-coverage, eligibility, and Medicare conditions. The Additional Contribution Amount Worksheet uses $1,000 times eligible months, divided by 12; line 8 adds lines 6 and 7.

Lines 9–13: employer amounts, IRA funding distributions, and the deduction

Line 9 reports employer contributions, including employee payroll contributions made through a cafeteria plan. Form W-2 box 12, code W usually supplies the starting figure. Use the Employer Contribution Worksheet if the W-2 includes employer contributions made in 2025 for 2024, or if employer contributions for 2025 are made in 2026. Line 10 is narrower: it is only a direct trustee-to-trustee transfer from a traditional or Roth IRA to the HSA. It is not income or a deduction, but it reduces remaining contribution capacity and has its own testing period.

1. Line 11: add lines 9 and 10.

2. Line 12: subtract line 11 from line 8; enter zero if the result is zero or less.

3. Line 13: generally enter the smaller of line 2 or line 12, then report that deduction on Schedule 1 (Form 1040), Part II, line 13.

Part III: report HSA distributions and calculate taxable amounts (lines 14a–17b)

Lines 14a–14c: find the net HSA distributions

Part II starts with all 2025 HSA distributions, generally the amount in Form 1099-SA box 1. Put that total on line 14a. On line 14b, enter only distributions included in line 14a that were rolled over to another HSA, plus qualifying excess contributions and related earnings that were withdrawn by the due date of the return, including extensions. Line 14c is line 14a minus line 14b. That net amount—not simply every withdrawal—is tested against qualified expenses.

Line 15: which HSA-paid expenses can offset distributions

Line 15 includes HSA distributions used for qualified medical expenses that were not reimbursed by insurance or other coverage and were incurred after the HSA was established. It can include qualifying expenses for you, your spouse, dependents, and certain people who would be dependents except for the listed tax exceptions. Do not include an excess-contribution distribution removed after the return due date, including extensions, even if it was used for medical expenses. An amount entered here cannot also be claimed as a Schedule A medical-expense deduction.

Lines 16–17b: taxable distributions and the additional 20% tax

1. Line 16: subtract line 15 from line 14c. Enter zero if the result is zero or less. Include a positive line 16 amount on Schedule 1 (Form 1040), Part I, line 8f.

2. Line 17a: check the box if any amount included on line 16 was distributed after the account beneficiary died, became disabled, or turned age 65.

3. Line 17b: multiply by 20% only the portion of line 16 that does not meet one of those exceptions. Include the result on Schedule 2 (Form 1040), Part II, line 17c.

Part IV: when the last-month rule or IRA-to-HSA transfer creates income and a 10% tax

Part III is not a routine penalty for taking money from an HSA. Use it only if you failed to remain an eligible individual during the testing period that followed use of the last-month rule or receipt of a qualified HSA funding distribution. For the last-month rule, the testing period begins with the last month of the tax year; for most calendar-year taxpayers, the IRS example runs from December 1, 2025, through December 31, 2026. For an IRA-to-HSA funding distribution, it begins in the month of the contribution and ends on the last day of the 12th following month. The IRS example of a June 17, 2025 contribution ends June 30, 2026.

Death or disability is an exception to the stated consequence for failing to remain eligible. Otherwise, report the result in the year eligibility fails. For line 18, use the contribution-year Line 3 Limitation Chart and Worksheet to find what could have been contributed without the last-month rule; enter the excess over that redetermined amount. Line 19 is the total qualified HSA funding distribution. Add lines 18 and 19 on line 20 and include it on Schedule 1, Part I, line 8f. Line 21 is 10% of line 20 and goes to Schedule 2, Part II, line 17d.

Special situations and official next steps

If the account beneficiary died and the surviving spouse is the designated beneficiary, the surviving spouse completes Form 8889 as though the HSA belonged to that spouse. If the designated beneficiary is not the surviving spouse, or there is no designated beneficiary, the IRS uses a different procedure: write “Death of HSA account beneficiary” across the form, use the beneficiary’s identity information, skip Part I, enter the HSA fair market value at death on line 14a, and follow the Part II instructions. The distribution is not subject to the additional 20% tax. An estate beneficiary has a separate Part I exception if applicable, so use the full IRS death-of-beneficiary instructions.

If current-year personal contributions on line 2 exceed line 13, follow the Form 8889 excess-contribution instructions and Form 5329 rather than treating the difference as an ordinary deduction adjustment. Those instructions address whether a timely withdrawal changes the treatment and whether an additional tax applies.

Can I receive an HSA distribution when I am no longer eligible to contribute?

Yes. You can receive an HSA distribution even when you are no longer eligible to have contributions made to the HSA. Contribution eligibility and distribution treatment are different questions: qualified medical use controls whether the distribution is excluded from income, while an amount not used for qualified medical expenses is generally taxable and may face the additional 20% tax unless an exception applies.

Sources and how this page was made

This guide explains the official sources listed below in plain language. Displayed amounts, limits, percentages, and timing rules come from that material.

Source revision reflected in this guide: Form: 2025; Instructions: 2025.

• Official form: 2025 Form 8889 — IRS

• Official form instructions: 2025 Instructions for Form 8889 — IRS

• Official supporting source: Form 8853 — IRS