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1099 Forms

Form 1099-SA Instructions: What It Reports, Who Must File, and How to Complete It Correctly

Updated: June 5, 2026

Key Takeaways

  • Form 1099-SA is filed by trustees or custodians to report the distributions from a Health Savings Account (HSA), Archer Medical, Medical Savings Account (Archer MSA), or Medicare Advantage Medical Savings Account (MA MSA).
  • Normal distributions, returned excess HSA or Archer MSA contributions with earnings, certain death-related distributions, prohibited transactions, disability distributions, and distributions from an HSA closed for failure to comply with the USA PATRIOT Act are reportable on Form 1099-SA.
  • Form 1099-SA uses Box 1 to report the gross distribution, Box 2 for earnings on excess contributions, Box 3 for the distribution code, Box 4 for the account’s fair market value on the date of death, and Box 5 to identify whether the account is an HSA, Archer MSA, or MA MSA.

Tax-advantaged medical savings accounts like Health Savings Account (HSA), Archer Medical, Medical Savings Account (Archer MSA) and Medicare Advantage Medical Savings Account (MA MSA) are used to help pay for medical expenses. Distributions from these savings accounts are reported to the IRS using Form 1099-SA.

What is Form 1099-SA and Who Needs to File the Form?

According to the Form 1099-SA instructions, the IRS requires distributions made from certain medical savings accounts to be reported to them. This form (1099-SA) is used to report distributions from a Health Savings Account (HSA), Archer Medical Savings Account (Archer MSA), and Medicare Advantage MSA (MA MSA). It doesn’t matter whether the money goes to the account holder or straight to a medical provider; any time money ispaid out of the account, it has to be reported. If someone has more than one type of these medical savings accounts, a separate Form 1099-SA must be filed for each account type.

Who is required to file Form 1099-SA?

When it comes to who must file Form 1099-SA, it is typically filed by the trustee or custodian of the health account that made the distribution. The trustee or custodian could be a bank, an insurance company, or even a credit union.

Note: The trustee or custodian is the one who reports the distribution, but they do not determine whether the amount is taxable.

What are the Filing Triggers for Form 1099-SA?

Unlike other 1099 forms which usually have a minimum reporting threshold, Form 1099-SA is filed only if a reportable distribution was made. That means, even a small distribution, of say, $100, can require filing.

  • All normal distributions to the account holder are reportable. The distribution code for this type of distribution is Code 1.
  • Direct payments to a doctor, hospital, pharmacy, or other medical service provider are reportable only if the distribution is made to the account holder. It also uses Code 1.
  • Excess distribution or excess amount from an HSA or Archer MSA account that is later returned are reportable using Distribution Code 2. Earnings from the distribution are reported in Box 2.
  • Certain death-related distributions to a surviving spouse, estate, or other non-spouse beneficiary are reportable using Distribution Code 4.
  • Distributions connected to a prohibited transaction that violates HSA or Archer MSA rules uses Distribution Code 5.
  • Disabled account holder receiving distributions after they become disabled is also reportable and requires distribution Code 3.
  • Distributions made after closing an HSA account due to failure to comply with the USA PATRIOT Act must also be reported using Distribution Code 6.

Special Reporting Rules & Exceptions Regarding Form 1099-SA Reporting

Form 1099-SA is a distribution form only. It does not report any contributions, rollover contributions received, qualified HSA funding distributions from an IRA to an HSA, or year-end fair market value. Those are reported on Form 5498-SA. Not every distribution from a medical account is reported to the IRS.

  • Transfers are not distributions: Trustee-to-trustee transfers between HSAs and MSAs are not considered as contributions or rollovers and do not have to be reported on Form 1099-SA.
  • Mistaken HSA distributions and repayments can be excluded: If an HSA distribution was mistakenly sent and later returned by the account beneficiary, no reporting is required.
  • Rules for death cases: In cases where the account holder dies, reporting depends on who receives the account, such as a spouse, estate, or non-spouse beneficiary, and when the distribution is made, whether it was made in the year of death or after the year of death. Distribution made to a beneficiary in the year of death generally uses code 4 in Box 3, while Box 4 reports the fair market value on the date of death. If a distribution is made after the year of death, the Box 3 code depends on the beneficiary: code 1 for spouse, code 4 for estate, or code 6 for a non-spouse beneficiary.

Note on Form 5498-SA:

Forms 1099-SA and 5498-SA both serve different purposes, though they are both related to medical savings accounts. Form 1099-SA reports distributions, while Form 5498-SA reports contributions, rollovers, and fair market value.

Form 1099-SA Box-by-Box Filing Instructions

IRS Form 1099-SA instructions provide box-by-box guidance for reporting distributions from an HSA, Archer MSA, or MA MSA. Here is a box-by-box breakdown of what to report:

Box What to report
Box 1: Gross Distribution The total gross distribution from the HSA, Archer MSA, or MA MSA goes in this box. This includes money paid to the account holder, a medical provider, or a beneficiary after the account holder dies. Earnings from excess contributions are also included here.
Box 2: Earnings on Excess Contributions Only the earnings connected to excess HSA or Archer MSA contributions that were later returned are reported in this box.
Box 3: Distribution Code This box explains what type of distribution is being reported using codes. Each code is linked to a specific distribution.

  • Code 1: Normal distributions
  • Code 2: Excess contributions returned to account holder
  • Code 3: Distributions made after account holder became disabled
  • Code 4: Death distribution, except certain non-spouse beneficiary payments
  • Code 5: Distributions related to prohibited transaction
  • Code 6: Death distribution after year of death to a non-spouse beneficiary
Box 4: FMV on Date of Death This box is only used when the account holder dies. It reports the fair market value (FMV) of the account on the date of death.
Box 5: Checkbox This checkbox identifies the type of account and whether it’s a HSA, Archer MSA, or MA MSA.

Form 1099-SA Due Date and Penalties: When to File The Form?

Filing requirement Original Deadline Deadlines for 2026 TY (to be filed in 2027)*
Recipient copy distribution January 31 February 1, 2027
Paper filing February 28 March 1, 2027
Electronic Filing (eFiling) March 31 March 31, 2027

* If a date falls on a weekend or holiday, the due date usually shifts to the next business day.

Penalties for late-filing or incorrect filing

Form 1099-SA is usually not subject to the tiered late-filing penalty schedule under sections 6721 and 6722. Instead, under section 6693, the IRS charges $50 per return for failure to file Form 1099-SA on time, with no maximum limit.

Pre-Filing Checklist to help you avoid making Form 1099-SA Filing Mistakes

A pre-filing checklist is a necessity, especially if you are dealing with complex Form 1099-SA instructions. But before we get into the checklist, let’s take a look at a few common filing mistakes revolving around Form 1099-SA.

  • Trustee-to-trustee distributions are generally not reported on Form 1099-SA.
  • Accidentally using the wrong Box 3 distribution code to identify the type of distribution that is being reported.
  • Confusing Form 1099-SA with Form 5498-SA. Form 1099-SA is for distributions, while Form 5498-SA reports contributions, rollovers, and fair market value.
  • Not reporting earnings on excess contributions on Box 2 and checking the wrong account type in Box 5 can cause filing errors.

Use this pre-filing checklist to avoid these common Form 1099-SA filing mistakes.

  • Always check the correct account type in Box 5. This checkbox lets you confirm whether the account is an HSA, Archer MSA, or MA MSA, since each medical savings account type requires separate reporting.
  • Make sure to verify recipient details, including name, address, TIN, and beneficiary information. Use an eFiling platform, like Tax1099 that includes TIN match, USPS address validation, and other data checks in the filing workflow.
  • Use the correct code to classify the transaction. Each distribution is given a specific code. Normal distribution is Code 1, excess contribution is Code 2, disability distribution is Code 3, prohibited transaction is Code 5, and death-related distributions are either Code 4 or 6.
  • Always review box-by-box data before filing, especially Box 1 amount, Box 2 earnings on excess contributions, and Box 3 distribution code.

When is Form 1099-SA Relevant? Real-Life Use Cases Explained

1. Normal HSA reimbursement

If a participant receives $900 from an HSA for medical reimbursement, since it is a distribution, the amount is reportable in Box 1.

2. Direct payment to a medical provider

If an HSA trustee pays a hospital directly and the money doesn’t go to the account holder first; it is still a reportable distribution and has to be reported on Form 1099-SA by using code 1 in Box 3.

3. Returned excess HSA contribution with earnings

If there are excess HSA contributions that were returned, report it on the form and mention the gross amount in Box 1, excess earnings in Box 2, and use Code 2 in Box 3.

4. Trustee-to-trustee account movement

Transferring funds from one HSA trustee to another is not reportable on Form 1099-SA.

5. Contribution instead of distribution

If a trustee reports annual HSA contributions and year-end account value, it has to be reported on Form 5498-SA. Contributions should not be reported on Form 1099-SA.

FAQs

1. Is Form 1099-SA filed only when distributions exceed a threshold amount?

Form 1099-SA does not have a reportable threshold amount. The form has to be filed for all amounts if it is considered a distribution.

2. Who must file Form 1099-SA?

Form 1099-SA is usually filed by the trustee or custodian of the account.

3. What is the difference between Form 1099-SA and Form 5498-SA?

Form 1099-SA reports distributions while Form 5498-SA reports contributions, rollover contributions received, qualified HSA funding distributions from an IRA to an HSA, and fair market value.

4. Do direct payments to doctors or hospitals still count as 1099-SA distributions?

Yes, payments made to doctors, hospitals, and medical service providers are considered distributions and must be reported on Form 1099-SA.

5. Are trustee-to-trustee transfers reportable on Form 1099-SA?

No, trustee-to-trustee transfers are not reported on Form 1099-SA.

6. What happens if the filer misses the deadline?

If a filer misses Form 1099-SA filing deadline, they will have to pay a penalty of $50 per return with no maximum, unless there is a reasonable cause.

Don’t miss out on reporting distributions

Report HSA, Archer MSA & MA MSA distributions accurately with Form 1099-SA.

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