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Official form guide
Form 5498-SA: HSA, Archer MSA, or Medicare Advantage MSA Information
IRS Form 5498-SA is used by trustees to report annual contributions, rollovers, and the fair market value of HSA, Archer MSA, or Medicare Advantage MSA accounts; box 5 shows the account’s fair market value.
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IRS Form 5498-SA - HSA, Archer MSA, or Medicare Advantage MSA Information
IRS Form 5498-SA is used by trustees to report annual contributions, rollovers, and the fair market value of HSA, Archer MSA, or Medicare Advantage MSA accounts; box 5 shows the account’s fair market value.
Risk Radar
Scan points- 1Do not attach Form 5498‑SA to your tax return.
- 2Leaving the trustee’s TIN blank on the form.
- 3Failing to report contributions in the correct box (e.g., placing rollover amounts in box 2).
- 4Omitting the fair market value in box 5.
- 5Not indicating the account type in box 6.
Plain English
The trustee of your health savings account sends Form 5498‑SA to the IRS each year. It tells the IRS how much was contributed to your HSA, Archer MSA, or Medicare Advantage MSA and what the account was worth at year‑end. You keep the copy for your records, not for filing with your tax return.
Submission Date
- Filing date: 2025-12-22 15:10:46
- Preparation window: collect IDs, supporting records, and signatures in advance.
- Final review: verify names, dates, and required fields before submission.
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What this form is for
- Use this form when a trustee must report annual contributions, rollovers, and the fair market value for an HSA, Archer MSA, or Medicare Advantage MSA.
- Do not use it when filing your individual income tax return; the form is not attached to the return.
- Check Form 8889 instead when you need to report HSA contributions on your individual tax return.
Form selector
Use this form or another form?
Reporting Archer MSA contributions on individual tax return
Archer MSA contributions are reported on Form 8853, not Form 5498‑SA
✓ Confirm you have Form 8853 completed
Reporting HSA contributions on individual tax return
HSA contributions are reported on Form 8889, separate from the informational Form 5498‑SA
✓ Verify Form 8889 includes all HSA contributions
Employer contributions shown on employee’s wage statement
Employer HSA or Archer MSA contributions appear on Form W-2, not on Form 5498‑SA
✓ Ensure employer contributions are correctly coded on Form W-2
Deadline or filing window
Not stated in the official source.
Checklist
What you need before filling it out
Box 1 – Employee’s or self‑employed person’s Archer MSA contributions made in the calendar year and the subsequent year for the calendar year
Contribution records from the trustee · Form 5498‑SA box 1
Box 2 – Total contributions made in the calendar year
Annual contribution summary · Form 5498‑SA box 2
Box 4 – Rollover contributions
Rollover documentation (e.g., IRA to HSA transfer record) · Form 5498‑SA box 4
Box 5 – Fair market value of HSA, Archer MSA, or MA MSA
Year‑end account statement showing balance · Form 5498‑SA box 5
Box 6 – Account type (HSA, Archer MSA, MA MSA)
Trustee’s account classification · Form 5498‑SA box 6
Before you submit
- 1Confirm the form revision date is Rev. December 2026.
- 2Verify the correct calendar year is entered at the top of the form.
- 3Check trustee’s name, address, and TIN for accuracy.
- 4Check participant’s name, address, and TIN for accuracy.
- 5Ensure the account number matches trustee records.
- 6Review boxes 1‑6 for correct amounts and correct account type.
- 7Retain Copy B for the participant and do not attach the form to the tax return.
- 8Confirm any required signature is present — not stated in the official source.
- 9Verify the form is marked as “Copy A” for IRS submission.
How to file this form
- 1Collect the trustee’s contribution, rollover, and balance statements — retain them as proof of filing.
- 2Enter all required data on Form 5498‑SA, including trustee and participant details and boxes 1‑6 — keep the completed form as proof.
- 3Separate the copies: keep Copy B for the participant and prepare Copy A for the IRS — proof is the retained Copy B.
- 4Submit Copy A to the IRS as instructed — proof is the mailing receipt or electronic confirmation.
Known limitations
- 1SSA contributions to a Medicare Advantage MSA are not includible in gross income nor deductible.
- 2Participants and employers cannot make contributions to a Medicare Advantage MSA.
- 3Boxes 2 and 3 contain information for IRS use only, not for the participant’s tax return.
Field map
Compact field-by-field guide
General Info
2 items
Full legal name and taxpayer identification number (SSN or EIN).
Current mailing address.
Details
2 items
Complete all applicable sections of this form according to the official IRS instructions.
Enter the relevant dollar amount if this form involves tax calculation.
Certification
1 items
Read and acknowledge any certifications required by this form.
Signatures
1 items
Sign and date. Unsigned forms cannot be processed.
Almost done reviewing the fields?
Fillable formOpen in Editor->The form is Rev. December 2026; the source points to the latest information page at www.irs.gov/Form5498SA.
What changed or needs a fresh check
- Edition date — confirm the revision reads Rev. December 2026 as shown on the form.
- Fee — not stated in the official source.
- Mailing address — not stated in the official source.
- Signature — not stated in the official source.
- Website — confirm the latest information page is www.irs.gov/Form5498SA.
Quick Facts
Downloads
After you file
- 1Confirm the form is not marked VOID or CORRECTED before using it.
- 2Do not attach Form 5498-SA to your income tax return; keep it for your records.
- 3Retain the form with your tax documents for future reference.
- 4If any information is incorrect, request a corrected Form 5498-SA from the trustee.
Sources
- SRCForm p.3 — SSA contributions to MA MSA aren’t includible in gross income nor deductible.
- SRCForm p.3 — Neither participant nor employer may contribute to a Medicare Advantage MSA.
- SRCForm p.3 — Boxes 2 and 3 information is for IRS use only.
- SRCForm p.1 — Form may be marked VOID or CORRECTED.
- SRCForm p.3 — Do not attach Form 5498-SA to your income tax return; keep it for your records.
- SRCForm p.2 — If information is incorrect, request a corrected Form 5498-SA from the trustee.
- SRCForm p.3 — Form may show only the last four digits of SSN for protection.
- SRCForm p.3 — Employer contributions to HSA are reported on Form W-2 box 12 (code W) or Archer MSA (code R).
Common confusion points
Why does my form only show the last four digits of my SSN?
The form protects privacy by displaying only the last four digits.
→ Verify the trustee reported your full TIN to the IRS.
Why are boxes 2 and 3 empty on my copy?
Boxes 2 and 3 are provided for IRS use only and not required for the participant.
→ Confirm you are reviewing the participant copy; these boxes are not needed for your return.
Should I attach Form 5498-SA to my tax return?
The form is informational and not to be attached.
→ Keep the form separate and do not file it with your return.
What does a VOID or CORRECTED label mean?
It indicates the form is invalid or has been amended.
→ Use the corrected version if one is issued.
Can I make contributions to my Medicare Advantage MSA?
Neither you nor your employer can contribute to a MA MSA.
→ Ensure no contributions are made; only SSA contributions apply.
Where are employer contributions to my HSA reported?
Employer contributions appear on Form W-2, box 12, code W.
→ Check your W-2 for code W in box 12.
Workflow map
Related forms and next steps
Before
Current
After
Often used with
⚠ If something goes wrong
- Request a corrected Form 5498‑SA from the trustee.
Questions about IRS Form 5498-SA
What is IRS Form 5498-SA used for?
The trustee of your health savings account sends Form 5498‑SA to the IRS each year. It tells the IRS how much was contributed to your HSA, Archer MSA, or Medicare Advantage MSA and what the account was worth at year‑end. You keep the copy for your records, not for filing with your tax return.
Who must file IRS Form 5498-SA?
The trustee of the HSA, Archer MSA, or Medicare Advantage MSA must file IRS Form 5498‑SA.
What information does IRS Form 5498-SA require?
The form reports the amounts contributed in boxes 1–4, any rollover contributions, the fair market value of the account in box 5, and the type of account in box 6.
How do I complete IRS Form 5498-SA?
The trustee fills out Copy A with the trustee’s name, address, and TIN, then enters the participant’s information and account number. Boxes 1 through 4 are completed with the appropriate contribution and rollover amounts, box 5 with the year‑end fair market value, and box 6 with the account type. After completing the form, the trustee retains Copy B for the participant and sends Copy A to the IRS. No signature line appears on the form.
Why does my form only show the last four digits of my SSN?
The form protects privacy by displaying only the last four digits. Verify the trustee reported your full TIN to the IRS.
Why are boxes 2 and 3 empty on my copy?
Boxes 2 and 3 are provided for IRS use only and not required for the participant. Confirm you are reviewing the participant copy; these boxes are not needed for your return.
Should I attach Form 5498-SA to my tax return?
The form is informational and not to be attached. Keep the form separate and do not file it with your return.
What does a VOID or CORRECTED label mean?
It indicates the form is invalid or has been amended. Use the corrected version if one is issued.
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