Page 21: Health Savings Accounts (HSAs)

Skip this page if neither of you held a Health Savings Account during 2026.

You need this page if either of you had an HSA — including an account nothing was paid into, if money came out of it.

What this page does. It reconciles each Health Savings Account: who owns it, what kind of plan it sits behind, what went in from every source, and what came out. Contributions over the limit are penalized each year they stay in the account, so the detail matters.

Before You Begin

Please gather the following documents:

  • Form 1099-SA (HSA distributions)
  • Form 5498-SA (HSA contributions and year-end value)
  • Form W-2, especially Box 12 Code W
  • HSA account statements
  • Records of any direct contributions you made to your HSA

Having these records available will make completing this page much easier.

Completing the Page

No HSA During the Year?

If neither you nor your spouse had a Health Savings Account during the year, simply check the box provided and continue to the next page.

One Section for Each HSA

HSAs are individually owned accounts, even when spouses are covered under the same health insurance plan.

If you have:

  • One HSA, complete one section.
  • Two HSAs (one for each spouse), complete two sections.
  • Additional HSAs due to account transfers or other circumstances, complete a section for each account.

Account Information

For each HSA, please provide:

Account Owner

Indicate whether the account belongs to:

  • Taxpayer
  • Spouse

Financial Institution or Custodian

Enter the name of the bank, credit union, brokerage firm, or other financial institution that maintains the HSA.

Coverage Type

Select the type of High Deductible Health Plan (HDHP) coverage you had:

  • Self-Only Coverage
  • Family Coverage

Months of HSA Eligibility

Enter the number of months during the year that you were covered by a qualifying High Deductible Health Plan.

This should be a number between:

  • 0 months
  • 12 months

The number of eligible months helps determine your allowable contribution limit.

Contributions Made to the HSA

Please report contributions from all sources separately.

Employer Contributions

Enter the amount contributed by your employer or church.

This amount is typically reported on:

Form W-2, Box 12, Code W

Payroll Contributions

If you contributed through payroll deduction on a pre-tax basis, include those amounts here when requested.

Direct Personal Contributions

Enter any contributions you made directly to the HSA from your own personal bank account.

Examples include:

  • Online transfers
  • Deposits made outside payroll
  • Contributions made directly to the HSA custodian

These contributions often qualify for a tax deduction and are especially important to report accurately.

Distributions from the HSA

If money was withdrawn from the account during the year, enter the amount reported on Form 1099-SA.

This includes distributions used for:

  • Medical expenses
  • Dental expenses
  • Vision expenses
  • Other qualified healthcare costs

Please include all distributions, even if they were used properly for qualified medical expenses.

Year-End Account Value

Enter the account balance reported on Form 5498-SA at year-end.

This helps us reconcile the account and confirm that contributions and distributions were reported properly.

Comments Section

Use the comments area to explain anything out of the ordinary, including:

  • Account transfers between custodians
  • Excess contributions that were corrected
  • Contributions made after year-end for the prior tax year
  • Non-medical distributions
  • HSA account closures
  • Medicare enrollment during the year

Providing a brief explanation can help us avoid follow-up questions later.

Common Mistakes to Avoid

Avoid Double-Counting Contributions

One of the most common mistakes occurs when HSA contributions reported on your W-2 are entered again as personal contributions.

Generally:

✅ Contributions shown in Box 12 Code W have already been reported.

❌ Do not enter the same amount again as a personal contribution.

Only enter additional contributions made directly from your own bank account in the personal contribution section.

Count Months of Coverage, Not Months the Account Existed

Your contribution limit is based on how many months you were covered by a qualifying High Deductible Health Plan.

For example:

  • An HSA account may remain open all year.
  • However, if you only had qualifying coverage for six months, your eligible contribution limit may be reduced.

Medicare Enrollment Affects Eligibility

In most situations, once Medicare coverage begins, HSA contribution eligibility ends.

If you enrolled in Medicare during the year, enter only the months you were eligible to contribute before Medicare coverage became effective.

If you’re unsure which months qualify, make a note in the comments section and we’ll review it with you.

Prior-Year Contributions Made After December 31

HSA contributions can often be made after year-end and designated for the prior tax year.

If you made a contribution in the following year but intended it for the current tax year:

  • Include the contribution amount
  • Note the contribution date in the comments section

Family Coverage Limits Apply to Both Spouses

When spouses are covered under a family High Deductible Health Plan, the annual family contribution limit is shared.

Having two HSA accounts does not create two separate family contribution limits.

Reporting all accounts helps us verify that contribution limits were not exceeded.

Report All Distributions

Even if every withdrawal was used for qualified medical expenses, please report the distribution.

The IRS receives Form 1099-SA directly from the HSA custodian, so the withdrawal should still be reported on your return.

If a distribution was used for a non-medical purpose, simply let us know and we’ll determine the proper tax treatment.

Include Both HSA Tax Forms

Whenever possible, please provide:

  • Form 1099-SA
  • Form 5498-SA

Together, these forms help us verify contributions, distributions, and year-end balances, ensuring your HSA information is reported correctly.

When You’re Finished

Before moving on, take a moment to confirm that you have:

✓ Listed each HSA separately

✓ Identified the account owner

✓ Entered coverage type and eligible months

✓ Reported employer contributions

✓ Reported personal contributions

✓ Included HSA distributions

✓ Entered the year-end account value

✓ Added notes for any unusual circumstances

A complete Page 21 helps us accurately report your HSA activity, identify any potential issues, and ensure you receive every tax benefit available. If you’re unsure about a contribution, distribution, or eligibility period, simply include a note in the comments section and we’ll be happy to review it with you.