IRS · Official form

Form 8853, Archer MSAs and Long-Term Care Insurance Contracts

Form 8853 covers three related items: Archer medical savings accounts, Medicare Advantage MSA distributions, and taxable payments from long-term care insurance or accelerated death benefits. Fill in the official IRS PDF below and download it.

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What is 8853?

Form 8853 reports activity in Archer MSAs, an older type of tax-favored medical savings account for employees of small employers and self-employed people. Section A figures the Archer MSA deduction for contributions and reports distributions, including the additional tax on money not used for qualified medical expenses. Section B handles distributions from Medicare Advantage MSAs.

Section C reports payments received under long-term care insurance contracts on a per diem or periodic basis and accelerated death benefits paid from a life insurance policy, working out how much, if any, is taxable. Amounts reported to you on Form 1099-SA or Form 1099-LTC generally feed into this form.

Who files 8853?

Taxpayers who contributed to or took distributions from an Archer MSA during the year
People who received distributions from a Medicare Advantage MSA
Anyone who received per diem or other periodic payments under a long-term care insurance contract
Recipients of accelerated death benefits from a life insurance policy

How to fill out 8853

Complete Section A if you or your employer contributed to an Archer MSA: figure the deductible contribution limit and enter any distributions from Form 1099-SA.
Report Medicare Advantage MSA distributions in Section B and mark how much was used for qualified medical expenses.
Use Section C to report long-term care insurance payments and accelerated death benefits from Form 1099-LTC, and figure the taxable amount, if any.
Compute any additional tax on distributions that were not used for qualified medical expenses.
Download the completed PDF and attach it to your Form 1040; carry the deduction and any taxable amounts to the lines the instructions specify.

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Page 1 19 fields

Name(s) shown on return

Social security number of M S A account holder. If both spouses have M S As, see instructions.

1. Total employer contributions to your Archer M S A(s) for 2025.

2. Archer MSA contributions you made for 2025, including those made in 2026 by the unextended due date of your return that were for 2025.

3. Limitation from the Line 3 Limitation Chart and Worksheet in the instructions.

4. Compensation (see instructions) from the employer maintaining the high deductible health plan. (If self-employed, enter your earned

5. Archer M S A deduction. Enter the smallest of line 2, 3, or 4 here. Also include this amount on Schedule 1 (Form 1040), line 23.

6a. Total distributions you and your spouse received in 2025 from all Archer M S As (see instructions).

6b. Distributions included on line 6a that you rolled over to another Archer M S A or a health savings account. Also include any excess

6c. Subtract line 6b from line 6a.

7. Unreimbursed qualified medical expenses (see instructions).

8. Taxable Archer M S A distributions. Subtract line 7 from line 6c. If zero or less, enter 0. Also include this amount in the total on

9a. If any of the distributions included on line 8 meet any of the Exceptions to the Additional 20% Tax (see instructions), check here.

9b. Additional 20% tax (see instructions). Enter 20% (0.20) of the distributions included on line 8 that are subject to the additional 20%

10. Total distributions you received in 2025 from all Medicare Advantage M S As (see instructions).

11. Unreimbursed qualified medical expenses (see instructions).

12. Taxable Medicare Advantage M S A distributions. Subtract line 11 from line 10. If zero or less, enter 0. Also include this amount in

13a. If any of the distributions included on line 12 meet any of the Exceptions to the Additional 50% Tax (see instructions), check here.

13b. Additional 50% tax. Enter 50% (0.50) of the distributions included on line 12 that are subject to the additional 50% tax. See

Page 2 19 fields

Name of policyholder (as shown on return)

Social security number of policyholder.

If more than one Section C is attached, check here

Name of insured

Social security number of insured

15. In 2025, did anyone other than you receive payments on a per diem or other periodic basis under a qualified L T C insurance contract

15. No.

16. Was the insured a terminally ill individual? Yes. Note: If “Yes” and the only payments you received in 2025 were accelerated death

16. No.

17. Gross L T C payments received on a per diem or other periodic basis. Enter the total of the amounts from box 1 of all Forms 1099-L T C

18. Enter the part of the amount on line 17 that is from qualified L T C insurance contracts.

19. Accelerated death benefits received on a per diem or other periodic basis. Don't include any amounts you received because the insured

20. Add lines 18 and 19.

21. Multiply $420 by the number of days in the L T C period.

22. Costs incurred for qualified L T C services provided for the insured during the L T C period (see instructions).

23. Enter the larger of line 21 or line 22.

24. Reimbursements for qualified L T C services provided for the insured during the L T C period. Caution: If you received any

25. Per diem limitation. Subtract line 24 from line 23.

26. Taxable payments. Subtract line 25 from line 20. If zero or less, enter 0. Also include this amount in the total on Schedule 1 (Form

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Frequently asked questions

Is an Archer MSA the same as an HSA?

No. Health savings accounts are the newer, more common account and are reported on Form 8889. Archer MSAs are largely closed to new participants, but existing account holders still report contributions and distributions on Form 8853.

Are long-term care insurance benefits taxable?

Often not, but per diem payments above a daily limit can be partly taxable, and Section C of Form 8853 is where the math happens. The insurer reports what it paid you on Form 1099-LTC.

What if I spent an MSA distribution on something other than medical care?

The nonqualified portion is included in income and generally subject to an additional tax, which Form 8853 computes. Exceptions apply for distributions after death, disability, or reaching Medicare age; see the instructions.

Form 8853, Archer MSAs and Long-Term Care Insurance Contracts

What is 8853?

Who files 8853?

How to fill out 8853

Quick fill 8853 on this page

Frequently asked questions

Related forms

Form 8889, Health Savings Accounts (HSAs)

Form 1099-SA, Distributions From an HSA, Archer MSA, or Medicare Advantage MSA

Form 1099-LTC, Long-Term Care and Accelerated Death Benefits