U.S. Individual Income Tax Return Forms

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TREASURY/IRS AND OMB USE ONLY DRAFT

2025

Instructions for Form 8889
Health Savings Accounts (HSAs)
Section references are to the Internal Revenue Code unless
otherwise noted.

Future Developments
Go to IRS.gov/Form8889 for the latest information.

What's New

The amendments apply to plan years beginning after 2024.

Q&As on certain qualified medical expenses. You can
find answers to questions regarding whether certain costs
related to nutrition, wellness, and general health are medical
expenses that may be paid or reimbursed under an HSA at
IRS.gov/Individuals/Frequently-asked-questions-aboutmedical-expenses-related-to-nutrition-wellness-and-generalhealth.

!

CAUTION

Reminders

!

Preventive care for purposes of qualifying as a high deductible health plan under section 223. Notice 2024-75,
October 28, 2024, expands the list of preventive care benefits
permitted to be provided by a high deductible health plan
(HDHP) without a deductible, or with a deductible below the
applicable minimum deductible for the HDHP, to include
over-the-counter oral contraceptives (including emergency
contraceptives) and male condoms. Notice 2024-75 also
clarifies that (1) all types of breast cancer screening for
individuals who have not been diagnosed with breast cancer
are treated as preventive care, (2) continuous glucose
monitors for individuals diagnosed with diabetes are
generally treated as preventive care, and (3) the safe harbor
for absence of a deductible for certain insulin products
applies without regard to whether the insulin product is
prescribed to treat an individual diagnosed with diabetes or
prescribed for the purpose of preventing the exacerbation of
diabetes or the development of a secondary condition. (See
Notice 2024-75, 2024-44 I.R.B. 1026, available at
IRS.gov/irb/2024-44_IRB#NOT-2024-75.)
Expenses treated as amounts paid for medical care.
Notice 2024-71, October 28, 2024, provides a safe harbor
under section 213 of the Internal Revenue Code for amounts
paid for condoms. The Treasury Department and the IRS will
treat amounts paid for condoms as amounts paid for medical
care under section 213(d). Because amounts paid for
condoms are treated as expenses for medical care under
section 213(d), if the other requirements of section 213(a) are
met (for example, if a taxpayer's total medical expenses
exceed the 7.5% adjusted gross income limitation and are
not compensated for by insurance or otherwise), then
amounts paid by the taxpayer for condoms for the taxpayer,
the taxpayer's spouse, or the taxpayer's dependent are
deductible as expenses for medical care under section 213.
Additionally, because amounts paid for condoms are treated
as expenses for medical care under section 213(d), the
Aug 18, 2025

Ask your HSA trustee whether your HSA and trustee
meet the requirements of Code section 223.

CAUTION

Ask your health insurance provider(s) whether your
HDHP and any disregarded coverage meet the
requirements of Code section 223.

General Instructions
Purpose of Form
Use Form 8889 to:

•
•
•
•

Report contributions to your HSA,
Figure your HSA deduction,
Report distributions from HSAs, and
Figure amounts you must include in income and additional
tax you may owe if you fail to be an eligible individual.
Additional information. See Pub. 969, Health Savings
Accounts and Other Tax-Favored Health Plans, for more
details on HSAs. Also, see the Instructions for Form 1040 and
the Instructions for Form 1040-NR.

Who Must File

You must file Form 8889 if any of the following applies.
• You, your employer, or someone else, made contributions
to your HSA.
• Your HSA made a distribution.
• You failed to be an “eligible individual” during a “testing
period” and must recognize income.
• You acquired an interest in an HSA because of the death
of the account beneficiary. See Death of Account Beneficiary,
later.
If you (or your spouse, if filing jointly) received HSA
distributions in 2025, you must file Form 8889 with
CAUTION Form 1040, Form 1040-SR, or Form 1040-NR, even if
you have no taxable income or any other reason for filing
Form 1040, Form 1040-SR, or Form 1040-NR.

!

Instructions for Form 8889 (2025) Catalog Number 37971Y
Department of the Treasury Internal Revenue Service www.irs.gov

DRAFT

DRAFT

P.L. 119-21, July 4, 2025, amended Code section 223 to
provide that:
1. An HSA eligible individual may have disregarded
coverage (besides the HDHP) for telehealth and other remote
care.
2. A plan will not fail to be treated as a HDHP by reason
of failing to have a deductible for telehealth and other remote
care services.

amounts are also eligible to be paid or reimbursed under a
health FSA, Archer MSA, HRA, or HSA. However, if an
amount paid for condoms is paid or reimbursed under a
health FSA, Archer MSA, HRA, HSA, or any other health plan
or otherwise, it is not a deductible expense under section
213. (See Notice 2024-71, 2024-44 I.R.B. 1026, available at
IRS.gov/irb/2024-44_IRB#NOT-2024-71.)

Definitions

TREASURY/IRS AND OMB USE ONLY DRAFT

Eligible Individual

Last-month rule. You may consider yourself an "eligible
individual" for the entire year if you are an eligible individual
on the 1st day of the last month of the tax year (December 1,
for most individuals). You are then subject to a "testing
period". See below.
Testing period. The testing period begins with the last
month of your tax year and ends on the last day of the 12th
month following that month (for example, December 1, 2025
– December 31, 2026). If you fail to remain an eligible
individual during this period, other than because of death or
becoming disabled, you will have to include in income the
total contributions made that would not have been made
except for the last-month rule. You include this amount in
income in the year in which you fail to be an eligible
individual. This amount is also subject to a 10% additional
tax. (See Part III.)

Account Beneficiary
The account beneficiary is the individual on whose behalf the
HSA was established.

HSA
Generally, an HSA is a health savings account set up
exclusively for paying the qualified medical expenses of the
account beneficiary or the account beneficiary's spouse or
dependents.

Distributions From an HSA
Distributions from an HSA used exclusively to pay qualified
medical expenses of the account beneficiary, spouse, or
dependents are excludable from gross income. (See the
Line 15 instructions for information on medical expenses of
dependents.) You can receive distributions from an HSA even
if you are not currently eligible to have contributions made to
the HSA. Any part of a distribution not used to pay qualified
medical expenses is includible in gross income and is subject
to an additional 20% tax unless an exception applies.

Amounts you pay for personal protective equipment, such
as masks, hand sanitizer, and sanitizing wipes for you, your
spouse, and your dependents for the primary purpose of
preventing the spread of COVID-19 are treated as medical
expenses eligible to be reimbursed from an HSA.
The cost of home testing for COVID-19 for you, your
spouse, or your dependents is an eligible medical expense
for tax purposes, which may be paid or reimbursed from an
HSA.
You can find answers regarding whether certain costs
related to nutrition, wellness, and general health are medical
expenses that may be paid or reimbursed under an HSA at
IRS.gov/Individuals/Frequently-asked-questions-aboutmedical-expenses-related-to-nutrition-wellness-and-generalhealth.
Expenses incurred before you establish your HSA are not
qualified medical expenses. If, under the last-month rule, you
are considered to be an eligible individual for the entire year
for determining the contribution amount, only those expenses
incurred after you actually establish your HSA are qualified
medical expenses.
You cannot treat insurance premiums as qualified medical
expenses unless the premiums are for:
1. Long-term care (LTC) insurance,
2. Health care continuation coverage (such as coverage
under COBRA),
3. Health care coverage while receiving unemployment
compensation under federal or state law, or
4. Medicare and other health care coverage if you were
65 or older (other than premiums for a Medicare
supplemental policy, such as Medigap).
Coverage under (2) and (3) can be for your spouse or

TIP a dependent meeting the requirement. For (4), if you,

the account beneficiary, are under age 65, Medicare
premiums for your spouse or dependents (who are age 65 or
older) are generally not qualified medical expenses.

High Deductible Health Plan
An HDHP is a health plan that meets the following
requirements.

Qualified Medical Expenses
Generally, “qualified medical expenses” for HSA purposes
are unreimbursed medical expenses that could otherwise be
deducted on Schedule A (Form 1040). See the Instructions
2

Instructions for Form 8889 (2025)

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DRAFT

To be eligible to have contributions made to your HSA, you
must be covered under a high deductible health plan (HDHP)
and have no other health coverage except certain
disregarded coverage. If you are an eligible individual,
anyone can contribute to your HSA. However, you cannot be
enrolled in Medicare or be another person's dependent. An
individual does not fail to be treated as an eligible individual
for any period merely because the individual receives
hospital care or medical services under any law administered
by the Secretary of Veterans Affairs for a service-connected
disability. You will not fail to be considered an eligible
individual because you receive benefits from a health plan
under surprise billing laws. You must be, or be considered, an
eligible individual on the first day of a month to take an HSA
deduction for that month (see Last-month rule next).

for Schedule A and Pub. 502, Medical and Dental Expenses.
As the HSA account beneficiary, you can pay these expenses
for medical care for yourself, your spouse, and your
dependents. Even though nonprescription medicines (other
than insulin) do not qualify for the medical and dental
expenses deduction, they do qualify as expenses for HSA
purposes. The cost of menstrual care products (tampons,
pads, liners, cups, sponges, or other similar products) are
also reimbursable for HSA purposes. Amounts paid for
condoms are treated as amounts paid for medical care and
qualify as reimbursable expenses for HSA purposes.

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Self-only
coverage

Family coverage

Minimum annual deductible

$1,650

$3,300

Maximum annual
out-of-pocket expenses*

$8,300

$16,600

Safe harbor for absence of deductible for certain insulin
products. In general, a plan will not fail to be treated as a
high deductible health plan by reason of failing to have a
deductible for selected insulin products. (See Code section
223(c)(2)(G).) This applies without regard to whether the
insulin product is prescribed to treat an individual diagnosed
with diabetes or prescribed for the purpose of preventing the
exacerbation of diabetes or the development of a secondary
condition. (See Notice 2024-75.)
Safe harbor for absence of preventive care deductible.
A plan will not fail to be treated as a high deductible health
plan by reason of failing to have a deductible for preventive
care. (See Code section 223(c)(2)(C) and Notice 2024-75.)
Safe harbor for absence of deductible for telehealth. A
plan will not fail to be treated as a high deductible health plan
by reason of failing to have a deductible for telehealth and
other remote care services. (Code section 223(c)(2)(E).)
Special rule for surprise billing. A plan will not fail to be
treated as a high deductible health plan by reason of
providing benefits for medical care in accordance with
surprise billing laws prior to the satisfaction of a deductible.
(Code section 223(c)(2)(F).)
Certain coverage disregarded. An eligible individual may
have:
1. Coverage for any benefit provided by permitted
insurance, and
2. Coverage for accidents, disability, dental care, vision
care, long-term care, or telehealth and other remote care.
(Code section 223(c)(1)(B).)
Permitted insurance. Permitted insurance means:
A. Insurance if substantially all of the coverage provided
relates to:
1. Liabilities incurred under workers’ compensation laws,
2. Tort liabilities, and/or,
3. Liabilities relating to ownership or use of property;
B. Insurance for a specified disease or illness; and
C. Insurance paying a fixed amount per day (or other period)
of hospitalization.

Death of Account Beneficiary
If the account beneficiary's surviving spouse is the
designated beneficiary, the HSA is treated as if the surviving
spouse were the account beneficiary. The surviving spouse
Instructions for Form 8889 (2025)

If the designated beneficiary is not the account
beneficiary's surviving spouse, or there is no designated
beneficiary, the account ceases to be an HSA as of the date
of death. The beneficiary completes Form 8889 as follows.
• Enter “Death of HSA account beneficiary” across the top of
Form 8889.
• Enter the name(s) shown on the beneficiary's tax return
and the beneficiary's SSN in the spaces provided at the top
of the form and skip Part I.
• On Part II, line 14a, enter the fair market value of the HSA
as of the date of death.
• On Part II, line 15, for a beneficiary other than the estate,
enter qualified medical expenses incurred by the account
beneficiary before the date of death that the beneficiary paid
within 1 year after the date of death.
• Complete the rest of Part II.
If the account beneficiary's estate is the beneficiary, the
value of the HSA as of the date of death is included on the
account beneficiary's final income tax return. Complete Form
8889 as described above, except you should complete Part I,
if applicable.
The distribution is not subject to the additional 20% tax.
Report any earnings on the account after the date of death as
income on your tax return.
Note. If, during the tax year, you are the beneficiary of two or
more HSAs or you are a beneficiary of an HSA and you have
your own HSA, you must complete a separate Form 8889 for
each HSA. Enter “statement” at the top of each Form 8889
and complete the form as instructed. Next, complete a
controlling Form 8889, combining the amounts shown on
each of the statement Forms 8889. Attach the statements to
your paper tax return after the controlling Form 8889.

Deemed Distributions From HSAs
The following situations result in deemed distributions from
your HSA.
• You engaged in any transaction prohibited by section 4975
with respect to any of your HSAs, at any time in 2025. Your
account ceases to be an HSA as of January 1, 2025, and you
must include the fair market value of all assets in the account
as of January 1, 2025, on line 14a.
• You used any portion of any of your HSAs as security for a
loan at any time in 2025. You must include the fair market
value of the assets used as security for the loan as income on
Schedule 1 (Form 1040), line 8f.
Any deemed distribution will not be treated as used to pay
qualified medical expenses. Generally, these distributions are
subject to the additional 20% tax.

Rollovers
A rollover is a tax-free distribution (withdrawal) of assets from
one HSA or Archer MSA that is reinvested in another HSA of
the same account beneficiary. Generally, you must complete
the rollover within 60 days after you received the distribution.
An HSA can only receive one rollover contribution during a
1-year period. See Pub. 590-A, Contributions to Individual
Retirement Arrangements (IRAs), for more details and
additional requirements regarding rollovers.
3

DRAFT

DRAFT

* This limit does not apply to deductibles and expenses for out-of-network
services if the plan uses a network of providers. Instead, only deductibles
and out-of-pocket expenses (such as copayments and other amounts, but
not premiums) for services within the network should be used to figure
whether the limit is reached.

completes Form 8889 as though the HSA belonged to the
surviving spouse.

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Note. If you instruct the trustee of your HSA to transfer funds
directly to the trustee of another of your HSAs, the transfer is
not considered a rollover. There is no limit on the number of
these transfers. Do not include the amount transferred in
income, deduct it as a contribution, or include it as a
distribution on line 14a.

Tax on excess contributions
Code section 4973 imposes a 6% tax on excess
contributions to an HSA. See Code section 4973 and Form
5329.

Specific Instructions
Name and social security number (SSN). Enter your
name(s) as shown on your tax return and the SSN of the HSA
account beneficiary. If married filing jointly and both you and
your spouse have HSAs, complete a separate Form 8889 for
each of you.

Use Part I to figure:
• Your HSA deduction,
• Any excess contributions you made (or those made on
your behalf), and
• Any excess contributions made by an employer (see
Excess Employer Contributions, later).

Figuring Your HSA Deduction

The maximum amount that can be contributed to your HSA
depends on the type of HDHP coverage you have. If you have
self-only coverage, your maximum contribution is $4,300. If
you have family coverage, your maximum contribution is
$8,550.
Note. If you are age 55 or older at the end of your tax year,
you can make an additional contribution of $1,000.
Your maximum contribution is reduced by any employer
contributions to your HSA, any contributions made to your
Archer MSA, and any qualified HSA funding distributions.
You cannot deduct any contributions for any month in
which you were enrolled in Medicare. Also, you cannot
deduct contributions if you are someone else's dependent for
2025.

How To Complete Part I

If both you and your spouse have HSAs, complete lines 1
through 13 as instructed on the form. However, if you and
your spouse are both eligible individuals and either of you
has an HDHP with family coverage, you both are treated as
having only the family coverage plan. Disregard any plans
with self-only coverage.
Complete a separate Form 8889 for each spouse.
Combine the amounts on line 13 of both Forms 8889 and
enter this amount on Schedule 1 (Form 1040), line 13. Be
sure to attach both Forms 8889 to your paper tax return.

Line 1

If you were covered, or considered covered, by a self-only
HDHP and a family HDHP at different times during the year,
check the box for the plan that was in effect for a longer
period. If you were covered by both a self-only HDHP and a
4

Line 2

Include on line 2 only those amounts you, or others on your
behalf, contributed to your HSA for 2025. Also, include
amounts contributed for 2025 made in 2026 by the
unextended deadline for filing your 2025 federal income tax
return, April 15, 2026. If you were serving in, or in support of,
the U.S. Armed Forces in a designated combat zone or
contingency operation, you may be able to file later. See Pub.
3 for details. Thus, you may contribute to your 2025 HSA
through April 15, 2026, or a later date if you served in a
designated combat zone or contingency operation.
Do not include employer contributions (see line 9) or
amounts rolled over from another HSA or Archer MSA. See
Rollovers, earlier. Also, do not include any qualified HSA
funding distributions (see line 10). Payroll contributions
through a salary reduction agreement elected by an
employee (a cafeteria plan) are treated as employer
contributions and are not included on line 2.

Line 3

When figuring the amount to enter on line 3, apply the
following rules.
1. Use the family coverage amount if you or your spouse
had an HDHP with family coverage. Disregard any plan with
self-only coverage.
2. If the last-month rule (see Last-month rule, earlier)
applies, you are considered an eligible individual for the
entire year. You are treated as having the same HDHP
coverage for the entire year as you had on the first day of the
last month of your tax year.
3. If you were, or were considered, an eligible individual
for the entire year and you did not change your type of
coverage, enter $4,300 for a self-only HDHP or $8,550 for a
family HDHP on line 3. (See (6) in this list.)
4. If you were, or were considered, an eligible individual
for the entire year and you changed your type of coverage
during the year, enter on line 3 (see (6) in this list) the greater
of:
a. The limitation shown on the last line of the Line 3
Limitation Chart and Worksheet (in these instructions), or
b. The maximum amount that can be contributed based
on the type of HDHP coverage you had on the first day of the
last month of your tax year.
If you had family coverage on the first day of the last

TIP month, you do not need to use the worksheet; enter
$8,550 on line 3.

5. If you were not an eligible individual on the first day of
the last month of your tax year, use the Line 3 Limitation
Chart and Worksheet (in these instructions) to determine the
amount to enter on line 3. (See (6) in this list.)
6. If, at the end of 2025, you were age 55 or older and
unmarried or married with self-only HDHP coverage for the
entire year, you can increase the amount determined in (3) or
(4) by $1,000 (the additional contribution amount). The
$1,000 additional contribution amount is not allocable among
Instructions for Form 8889 (2025)

DRAFT

DRAFT

Part I—HSA Contributions and
Deductions

family HDHP at the same time, you are treated as having
family coverage during that period. If you and your spouse
are considered covered by a family HDHP, you are
considered covered by a family HDHP regardless of whether
you file jointly or separately. If, on the first day of the last
month of your tax year (December 1 for most taxpayers), you
had family coverage, check the “family” box.

TREASURY/IRS AND OMB USE ONLY DRAFT
spouses, unlike the $8,550 family contribution discussed
below. For the Line 3 Limitation Chart and Worksheet, the
additional contribution amount is included for each month
you are an eligible individual.

If you must complete the Line 3 Limitation Chart and

TIP Worksheet (in these instructions), and your eligibility

and coverage did not change from one month to the
next, enter the same number you entered for the previous
month.

DRAFT

DRAFT

Note. If you are married and had family coverage at any time
during the year, the additional contribution amount is figured
on line 7 and is not included on line 3.

See Pub. 969 for more information.

Instructions for Form 8889 (2025)

5

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Line 3 Limitation Chart and Worksheet
Before you begin: √ See the instructions for line 3, earlier.
√ Go through this chart for each month of 2025.
√ Keep for your records.
Start Here
Were you enrolled in Medicare for the month?

Yes

No
Were you an eligible individual (see Eligible
Individual, earlier) on the first day of the month
(see the line 3 instructions, earlier)?

No

Enter -0- on
the line below
for the month.

What type of coverage did your HDHP provide on the first day of the month?
Self-only coverage

Family coverage

Enter $4,300 on the line below
for the month. If you were age
55 or older at the end of 2025,
enter $5,300 for the month.

Enter $8,550 on the line below for
the month. If, at the end of 2025,
you were unmarried and age 55 or
older, enter $9,550 for the month.

Amount from
chart above

Month in 2025
January

. . . . . . . . . . . . . . . . . $

February

. . . . . . . . . . . . . . . . . $

March

. . . . . . . . . . . . . . . . . . $

April

. . . . . . . . . . . . . . . . . . . $

May

. . . . . . . . . . . . . . . . . . . $

June . . . . . . . . . . . . . . . . . . . $
July

. . . . . . . . . . . . . . . . . . . $

August

. . . . . . . . . . . . . . . . . . $

September
October

. . . . . . . . . . . . . . . . $
. . . . . . . . . . . . . . . . . $

November

. . . . . . . . . . . . . . . . $

December

. . . . . . . . . . . . . . . . $

Total for all months

. . . . . . . . . . . . . $

Limitation. Divide the total by 12.
Enter here and on line 3 . . . . . . . . . . . . $
6

Instructions for Form 8889 (2025)

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DRAFT

Yes

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Employer Contribution Worksheet

Keep for Your Records

1. Enter the employer contributions reported on your 2025 Form W-2, box 12, code W . . . . . . . . . . . . . . . . . . . . . .

2.

3. Subtract line 2 from line 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3.

4. Enter employer contributions made in 2026 for tax year 2025 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

4.

5. Employer contributions for 2025. Add lines 3 and 4. Enter here and on your 2025 Form 8889, line 9 . . . . . . .

5.

Line 6

Spouses who have separate HSAs and had family coverage
under an HDHP at any time during 2025, use the following
rules to figure the amount on line 6.
• If you are treated as having family coverage for each
month, divide the amount on line 5 equally between you and
your spouse, unless you both agree on a different allocation
(such as allocating nothing to one spouse). Enter your
allocable share on line 6.
• If you are not treated as having family coverage for each
month, use the following steps to determine the amount to
enter on line 6.
Step 1. Refigure the contribution limit that would have
been entered on line 5 if you had entered on line 3 the total of
the worksheet amounts only for the months you were treated
as having family coverage. When refiguring line 5, use the
same amount you previously entered on line 4.
Step 2. Divide the refigured contribution limit from Step 1
equally between you and your spouse, unless you both agree
on a different allocation (such as allocating nothing to one
spouse).
Step 3. Subtract the part of the contribution limit allocated
to your spouse in Step 2 from the amount determined in Step
1.
Step 4. Determine any other contribution limits that apply
for the tax year and add that amount to the result in Step 3.
Enter the total on line 6.

Line 7
Additional Contribution Amount
If, at the end of 2025, you were age 55 or older and married,
use the Additional Contribution Amount Worksheet (in these
instructions) if both of the following apply.
1. You or your spouse had family coverage under an
HDHP and were, or were considered to be, an eligible
individual on the first day of the month.
2. You were not enrolled in Medicare for the month.
Enter the result on line 7.
If items (1) and (2) apply to all months during 2025,

TIP enter $1,000 on line 7.

Instructions for Form 8889 (2025)

Additional Contribution Amount Worksheet
1. $1,000 × number of months eligible . . . . . . . . .
2. Divide line 1 by 12. Enter here and on
line 7 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Line 9
Employer Contributions
Employer contributions (including employee payroll
contributions through a cafeteria plan) include any amount an
employer contributes to any HSA for you for 2025. Also,
include contributions made by a health insurance plan on an
employer's behalf. These contributions should be shown on
Form W-2, box 12, code W. If either of the following apply,
complete the Employer Contribution Worksheet.
• Employer contributions for 2024 are included on your 2025
Form W-2, box 12, code W.
• Employer contributions for 2025 are made in 2026.
If your employer made excess contributions, you may have to
report the excess as income. See Excess Employer
Contributions, later.

Line 10
Qualified HSA funding distribution. A distribution from
your traditional IRA or Roth IRA to your HSA in a direct
trustee-to-trustee transfer is called an HSA funding
distribution. Note that these funds are not being distributed
from your HSA, but rather are being distributed from your IRA
and contributed to your HSA. Enter this amount on line 10.
The qualified HSA funding distribution is not included in
your income, is not deductible, and reduces the amount that
can be contributed to your HSA by you and from other
sources (including employer contributions). This distribution
cannot be made from an ongoing SEP IRA or SIMPLE IRA.
For this purpose, a SEP IRA or SIMPLE IRA is ongoing if an
employer contribution is made for the plan year ending with
or within your tax year in which the distribution would be
made.
The maximum amount that can be excluded from income
is based on your age at the end of the year and your HDHP
coverage (self-only or family) at the time of the distribution.
You can make only one qualified HSA funding distribution
during your lifetime. However, if you make the distribution
during a month when you have self-only HDHP coverage, you
can make another qualified HSA funding distribution in a later
month in that tax year if you change to family HDHP
coverage.
See the discussions under Line 13 for the treatment of
excess contributions.
See Pub. 969 for more information.
7

DRAFT

DRAFT

1.

2. Enter employer contributions made in 2025 for tax year 2024 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

TREASURY/IRS AND OMB USE ONLY DRAFT
Testing period. If you received a traditional IRA or Roth
IRA distribution, you must remain an eligible individual during
the testing period. The testing period begins with the month
in which the traditional IRA or Roth IRA distribution is
contributed to the HSA and ends on the last day of the 12th
month following that month. For example, if the distribution is
contributed on June 17, 2025, the testing period ends on
June 30, 2026. If you fail to remain an eligible individual
during this period, other than because of death or becoming
disabled, you will have to include the qualified HSA funding
distribution in income in the year in which you fail to be an
eligible individual. This amount is also subject to a 10%
additional tax. (See Part III.)

Line 13

Note. If the amount on line 2 is less than the amount on
line 12 and you have prior year excess contributions, see
Prior Year Excess Contributions, later.

Excess Contributions You Make
To figure your excess contributions (including those made on
your behalf), subtract your deductible contributions (line 13)
from your actual contributions (line 2). However, you can
withdraw some or all of your excess contributions for 2025
and they will be treated as if they had not been contributed if:
• You make the withdrawal by the due date, including
extensions, of your 2025 tax return (but see the Note under
Excess Employer Contributions, later);
• You do not claim a deduction for the amount of the
withdrawn contributions; and
• You also withdraw any income earned on the withdrawn
contributions and include the earnings in “Other income” on
your tax return for the year you withdraw the contributions
and earnings.

Excess Employer Contributions
Excess employer contributions are the excess, if any, of your
employer's contributions over your limitation on line 8. If you
made a qualified HSA funding distribution (line 10) during the
tax year, reduce your limitation (line 8) by that distribution
before you determine whether you have excess employer
contributions. If the excess was not included in income on
Form W-2, you must report it as “Other income” on your tax
return. However, you can withdraw some or all of the excess
employer contributions for 2025 and they will be treated as if
they had not been contributed if:
• You make the withdrawal by the due date, including
extensions, of your 2025 tax return (but see the following
Note);
• You do not claim an exclusion from income for the amount
of the withdrawn contributions; and
• You also withdraw any income earned on the withdrawn
contributions and include the earnings in “Other income” on
8

Note. If you timely filed your return without withdrawing the
excess contributions, you can still make the withdrawal no
later than 6 months after the due date of your tax return,
excluding extensions. If you do, file an amended return with
“Filed pursuant to section 301.9100-2” written at the top.
Include an explanation of the withdrawal. Make all necessary
changes on the amended return (for example, if you reported
the contributions as excess contributions on your original
return, include an amended Form 5329 reflecting that the
withdrawn contributions are no longer treated as having been
contributed).

Prior Year Excess Contributions
If your current year contributions from line 2 are less than
your current year maximum HSA contribution limit shown on
line 12 and you have prior year excess contributions, see the
Instructions for Form 5329, Part VII, line 43, for more
information.
Any excess contribution remaining at the end of the tax
year is subject to the additional tax. See Form 5329.

Part II—HSA Distributions
Line 14a

Enter the total distributions your HSAs made in 2025. These
amounts should be shown on Form 1099-SA, box 1.

Line 14b

Include on line 14b any distributions you received in 2025
that qualified as a rollover contribution to another HSA. See
Rollovers, earlier. Also include any excess contributions (and
the earnings on those excess contributions) included on
line 14a that were withdrawn by the due date, including
extensions, of your return. See the instructions for line 13,
earlier.

Line 15
Only include on line 15 distributions from your HSA
that were used to pay you for qualified medical
CAUTION expenses not reimbursed by insurance or other
coverage and that you incurred after the HSA was
established. Do not include the distribution of an excess
contribution taken out after the due date, including
extensions, of your return even if used for qualified medical
expenses.

!

In general, include on line 15 distributions from all HSAs in
2025 that were used for the qualified medical expenses of:
1. You and your spouse.
2. All your dependents.
3. Any person who would be a dependent except that:
a. The person filed a joint return.
b. The person had gross income.
c. You, or your spouse if filing jointly, are dependents of
someone else.

Instructions for Form 8889 (2025)

DRAFT

DRAFT

Generally, enter the smaller of line 2 or line 12 on line 13 and
on Schedule 1 (Form 1040), Part II, line 13. However, if the
amount on line 2 is more than the amount on line 13, you or
someone on your behalf (or your employer) contributed more
to your HSA than is allowable and you may have to pay an
additional tax on the excess contributions. Figure the excess
contributions using the following instructions. See Form
5329, Additional Taxes on Qualified Plans (Including IRAs)
and Other Tax-Favored Accounts, to figure the additional tax.

your tax return for the year you withdraw the contributions
and earnings.

TREASURY/IRS AND OMB USE ONLY DRAFT
For this purpose, a child of parents who are divorced,

TIP separated, or living apart for the last 6 months of the

calendar year is treated as the dependent of both
parents whether or not the custodial parent releases claim to
the child as the custodial parent’s dependent.

!

You cannot take a deduction on Schedule A (Form
1040) for any amount you include on line 15.

CAUTION

Lines 17a and 17b
Additional 20% Tax
HSA distributions included in income (line 16) are subject to
an additional 20% tax unless one of the following exceptions
applies.

Exceptions to the Additional 20% Tax

If any of the exceptions apply to any of the distributions
included on line 16, check the box on line 17a. Enter on
line 17b only 20% (0.20) of any amount included on line 16
that does not meet any of the exceptions.
Note. There may be very limited and unusual circumstances
in which you may be able to return mistaken distributions
such that the amount will not be subject to the additional tax.

Instructions for Form 8889 (2025)

Part III—Income and Additional Tax
for Failure To Maintain HDHP
Coverage

Use Part III to figure any additional income and adjustments
to income that must be reported on Schedule 1 (Form 1040)
and additional taxes that must be reported on Schedule 2
(Form 1040) for failure to be an eligible individual during the
testing period for:
• Last-month rule (see Last-month rule, earlier), or
• A qualified HSA funding distribution (see the Instructions
for line 10, earlier).
See the discussion, earlier, on determining the testing period
for both the last-month rule and a qualified HSA funding
distribution. Include the amount in income in the year in
which you fail to be an eligible individual.

Line 18

You can use the Line 3 Limitation Chart and Worksheet (in
these instructions) for the year the contribution was made to
determine the contribution you could have made if the
last-month rule did not apply. Enter on line 18 the excess of
the amount contributed over the redetermined amount.

DRAFT

DRAFT

The additional 20% tax does not apply to distributions made
after the account beneficiary:
• Dies,
• Becomes disabled or
• Turns age 65.

For more information, see Notice 2004-50, Q/A 37 and 76, at
IRS.gov/IRB/2004-33_IRB#NOT-2004-50.

Line 19

Enter the total of any qualified HSA funding distribution (see
line 10).

9