Healthcare

Form 5498-SA: HSA, Archer MSA, or Medicare Advantage MSA Information

Reports contributions to Health Savings Accounts, Archer MSAs, and Medicare Advantage MSAs, including rollover contributions and fair market value.

Download Form 5498-SA PDFAbout on IRS.govInstructions PDF

Who Files This Form?

HSA, Archer MSA, or Medicare Advantage MSA trustees or custodians.

Key Fields

  • Employee/self contributions
  • Employer contributions
  • Total contributions
  • Fair market value
  • Rollover contributions

Filing Deadlines

Due Date

May 31

Late Filing Penalty

Penalties range from $60 to $310 per form for late filing.

Related Forms

1099-SA

Distributions From an HSA, Archer MSA, or Medicare Advantage MSA

Form 8889

Health Savings Accounts (HSAs)

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