HSA tax documents: 1099-SA, 5498-SA, W-2 code W and Form 8889

A health savings account is an account for medical costs that you can fund only while you are covered by a high deductible health plan, or HDHP. Every HSA return item ends up on Form 8889, which you file with Form 1040 (IRS Publication 969). Three forms feed it, and they arrive at different times.

The timing trips people up. The custodian must give you Form 5498-SA by May 31 of the following year (Form 5498-SA instructions). By then most returns are in, so Form 8889 is usually built from the deposit history you download, and the 5498-SA only confirms it.

There are two routes into an HSA. Money through payroll shows on the W-2 in Box 12 code W, and it is already excluded from your wages (Form 8889 instructions). Money you send yourself, from your bank account, is the part you deduct on Form 8889, so keep the custodian’s confirmation for each deposit.

You can make contributions for 2025 through April 15, 2026 (IRS Publication 969). A deposit sent between New Year and the filing deadline is coded to one year or the other, so look at the year the custodian assigned before adding it up.

Your employer can also fund the prior year in that window. When it does, it must tell you and the custodian that the money is for 2025, and the amount shows on your 2026 W-2 (IRS Publication 969). Keep that notice, or the W-2 code W total will not match Form 8889.

For 2025, the limit is $4,300 with self-only HDHP coverage and $8,550 with family coverage (IRS Publication 969). For 2026, it is $4,400 and $8,750 (IRS Publication 969). If you are 55 or older at year end, your limit goes up by $1,000 (IRS Publication 969).

Coverage dates set the limit, so the file needs them. The last-month rule is the rule that treats a person eligible on December 1 as eligible for the whole year (IRS Publication 969). If you then lose eligibility during the testing period, part of the contribution comes back into income with a 10% additional tax (IRS Publication 969).

• Married couples: when either spouse has family coverage, the family limit is shared, so both spouses’ HSA statements belong in the file.
• Medicare: beginning with the first month you are enrolled in Medicare, your contribution limit is zero, even when enrollment is backdated (IRS Publication 969).
• Excess contributions: keep the custodian’s letter if an excess was taken out before the filing deadline.

Form 1099-SA reports every dollar that left the account, including debit card swipes. It does not say what the money paid for. That proof is yours to keep.

Your records must show three things (IRS Publication 969). Each distribution paid a qualified medical expense. Nobody else paid that expense. And you did not also claim it among your itemized medical costs. An itemized receipt or an explanation of benefits from the insurer does this well, such as a pharmacy receipt with the patient name and date.

Money not used for qualified medical expenses is taxed and may face an additional 20% tax (IRS Publication 969). There is no additional tax on distributions after you are disabled, reach age 65, or die (IRS Publication 969). The income tax still applies in those cases when the money did not pay a medical cost.

Moving money between HSAs leaves its own trail. A trustee-to-trustee transfer is a move made directly between two custodians, and it is not a contribution or a distribution on Form 8889 (IRS Publication 969). Keep the transfer statement anyway, because it explains why one account dropped and another rose.

Telehealth changed for plan years after 2024. A plan no longer fails to count as an HDHP because it covers telehealth before the deductible (IRS Publication 969). If a client had a telehealth add-on, that coverage alone no longer blocks HSA eligibility.

Two more doors opened for 2026. From 2026, bronze and catastrophic Marketplace plans count as HDHPs, and a direct primary care arrangement of up to $150 a month ($300 if it covers more than one person) no longer blocks contributions (IRS Notice 2026-5). The HSA can also pay that monthly membership fee (IRS Notice 2026-5). So a 2026 file needs the plan’s metal level, read from the Form 1095-A or the plan documents described on the health insurance checklist, and the DPC agreement showing its fee.

When the account holder dies, the beneficiary gets the Form 1099-SA. A spouse named as beneficiary can treat the account as their own (IRS Publication 969).

Send everything for the tax year in one batch, with the coverage dates written on top. A preparer can then check the limit before looking at any form.

1. Download Form 1099-SA from each HSA custodian, and the contribution history if Form 5498-SA is not out yet.
2. Add the W-2 and circle Box 12 code W.
3. Write down the HDHP start and end dates, self-only or family, for you and your spouse.
4. Match each withdrawal to a receipt or explanation of benefits.
5. Flag any Medicare start date, excess removal or transfer between accounts.

• IRS Publication 969: HSA limits for 2025 and 2026, the $1,000 catch-up, the last-month rule, the Medicare rule, record-keeping for distributions, the 20% additional tax, transfers, the telehealth change, and the employer notice for prior-year contributions made January 1 to April 15.
• IRS Notice 2026-5: For months beginning after December 31, 2025, bronze and catastrophic plans available as individual coverage through an Exchange are HDHPs; a direct primary care arrangement with fees up to $150 a month ($300 for more than one person) does not block HSA eligibility, and its fees can be paid from the HSA.
• Form 5498-SA instructions: The custodian must provide Form 5498-SA to the participant by May 31 of the following year.
• Form 8889 instructions: Employer contributions, including through a cafeteria plan, are shown on Form W-2, Box 12, code W.