What is Form 1099-SA? A Complete Guide to HSA Distributions in 2026

What is Form 1099-SA? If you’re enrolled in a Health Savings Account (HSA) or similar medical savings plan, understanding Form 1099-SA is crucial for accurate tax reporting. This form details distributions from your account, helping you determine if any amounts are taxable. In this comprehensive guide, we’ll break down what Form 1099-SA is, who needs it, how it impacts your taxes, and more. Whether you’re a first-time HSA user or managing distributions for medical expenses, this article provides everything you need to know for the 2025 tax year and beyond.

What is Form 1099-SA?

Form 1099-SA is an official IRS document that reports distributions made from certain types of medical savings accounts. Specifically, it covers payouts from:

  • Health Savings Accounts (HSAs)
  • Archer Medical Savings Accounts (Archer MSAs)
  • Medicare Advantage Medical Savings Accounts (MA MSAs)

These distributions might be paid directly to a healthcare provider or reimbursed to the account holder. The form ensures the IRS tracks these transactions for tax purposes, as not all distributions are tax-free.

Unlike contributions, which are reported on Form 5498-SA, Form 1099-SA focuses solely on money leaving the account. If you had any distributions in the previous year, you’ll receive this form by January 31 of the following year.

Who Files and Receives Form 1099-SA?

The responsibility for filing Form 1099-SA falls on the trustee, custodian, or issuer of the account—typically your bank, credit union, or financial institution managing the HSA or MSA. They must submit the form to both you (the account holder) and the IRS.

You’ll receive Form 1099-SA if:

  • You took any distributions from an HSA, Archer MSA, or MA MSA during the tax year.
  • The total distributions exceed $0, even if they were for qualified medical expenses.

Note that a separate Form 1099-SA is required for each type of plan. For example, if you have both an HSA and an Archer MSA, you’ll get two forms. If there were no distributions, no form is issued.

What Does Form 1099-SA Report? Breaking Down the Boxes

Form 1099-SA includes several key boxes that detail your distributions. Here’s a quick overview:

  • Box 1: Gross Distribution – The total amount distributed from the account, including both principal and earnings.
  • Box 2: Earnings on Excess Contributions – Any taxable earnings from contributions that exceeded annual limits.
  • Box 3: Distribution Code – Indicates the type of distribution (e.g., Code 1 for normal distributions, Code 2 for excess contributions).
  • Box 4: Fair Market Value (FMV) on Date of Death – Relevant if the account holder passed away and the account was transferred.
  • Box 5: Account Type – Specifies if it’s an HSA, Archer MSA, or MA MSA.

These details help you classify distributions as taxable or nontaxable when filing your taxes.

Tax Implications of HSA Distributions

HSA distributions are generally tax-free if used for qualified medical expenses, such as doctor visits, prescriptions, or dental care. However, if funds are used for non-qualified purposes, they become taxable income, and you may face a 20% penalty (unless you’re over 65 or disabled).

For Archer MSAs and MA MSAs, similar rules apply, but with some differences—Archer MSAs are less common and have stricter eligibility. Always keep receipts for medical expenses to substantiate tax-free status.

In recent years, including 2023 and 2024, there have been no major changes to Form 1099-SA reporting, but always check for updates on contribution limits or qualified expenses.

How to Use Form 1099-SA When Filing Your Taxes?

When tax season arrives, you’ll use the information from Form 1099-SA to complete related IRS forms:

Attach these to your Form 1040 if required. Tax software like TurboTax can import Form 1099-SA data directly, simplifying the process.

If you don’t receive your form by early February, contact your account provider. Electronic filing is common, so check your online portal.

Form 1099-SA doesn’t stand alone. Key related documents include:

  • Form 5498-SA: Reports contributions and year-end account value.
  • Form 1096: Used by filers as a transmittal for paper submissions.
  • Form 8851: Summary for Archer MSAs.

For the latest instructions, download the 2024 Instructions for Forms 1099-SA and 5498-SA from the IRS website. As of 2026, instructions remain consistent, with updates released annually.

Common FAQs About Form 1099-SA and HSA Distributions

What if my distributions were for qualified expenses?

They’re typically tax-free, but you still report them on Form 8889. No taxes or penalties apply.

Do I need to file Form 1099-SA myself?

No—your account custodian files it. You just use the info for your return.

What happens if distributions are taxable?

Add them to your income on Form 1040, and pay the 20% penalty if applicable.

Can I correct errors on Form 1099-SA?

Contact your provider for a corrected form if details are wrong.

Are there deadlines for filers?

Yes, forms must be sent to recipients by January 31 and filed with the IRS by February 28 (paper) or March 31 (electronic).

Final Thoughts on Managing HSA Distributions

Form 1099-SA is your key to compliant tax reporting for HSA and MSA distributions. By understanding its role, you can maximize tax advantages while avoiding penalties. Always consult a tax professional for personalized advice, especially with complex situations like rollovers or death benefits. Stay informed by visiting the IRS website regularly for any 2026 updates.

This guide is based on current IRS guidelines to help you navigate tax time with confidence. If you have more questions about HSAs, consider exploring contribution limits or investment strategies for long-term savings.