Fill Out Form 1099-SA, Distributions From an HSA, Archer MSA, or Medicare Advantage MSA
Reporting HSA or MSA distributions to account holders? Upload your 1099-SA PDF, and Simplicity AI fills in account details, distribution amounts, and the correct distribution codes. Whether you're a financial institution filing for hundreds of accounts or an individual making sense of a distribution you received, the AI walks you through every box in plain English.
AI converts the 1099-SA into an interactive form. No manually tapping into tiny PDF fields or second-guessing which distribution code applies.
Upload account records or statements as source documents, and AI pulls distribution amounts, account types, and fair market values directly into the right boxes.
Filing for multiple account holders? Auto-fill each 1099-SA from saved data. Same accuracy across all forms, with a fraction of the manual work.
Form INFORMATIONS
Payer/Trustee Info - Institution Details:
The name, address, and phone number of the financial institution (bank, credit union, or insurance company) that administers your HSA, Archer MSA, or Medicare Advantage MSA. This identifies the trustee or custodian to the IRS. If you're the trustee issuing this form, enter your institution's legal name exactly as registered with the IRS.
Payer's TIN:
The trustee's Employer Identification Number (EIN). This is the financial institution's tax ID, not the account holder's.
Recipient's TIN:
The account holder's Social Security Number (SSN), Individual Taxpayer Identification Number (ITIN), or EIN. For privacy, the form sent to the recipient may only show the last four digits, but the full number is reported to the IRS. This must match IRS records exactly.
Recipient's Name:
The account holder's full legal name. If the account holder has died and distributions are being reported to a beneficiary, the beneficiary's name and TIN appear here instead.
Recipient's Address:
The account holder's (or beneficiary's) current mailing address, including city, state, and ZIP code. If the account holder has moved since opening the account, verify that the address is updated before filing.
Account Number:
Optional, but the IRS encourages it on all 1099-SA forms. Required if you're filing more than one 1099-SA for the same recipient (for example, distributions from both an HSA and an Archer MSA for the same person in the same year).
Box 1 - Gross Distribution:
The total amount distributed from the account during the tax year. This includes direct payments to medical providers and amounts distributed to the account holder. It also includes any earnings reported separately in Box 2. The trustee is not required to determine whether the distribution is taxable. Do not include excess employer contributions returned to an employer or excess MA MSA contributions returned to the Secretary of Health and Human Services.
Box 2 - Earnings on Excess Contributions:
Only applies if the account holder contributed more than the IRS annual limit and withdrew the excess by the tax filing deadline. This box shows the earnings generated by those excess contributions while they sat in the account. These earnings are taxable. If no excess contributions were returned, leave this blank.
Box 3 - Distribution Code:
A single-digit code that tells the IRS what type of distribution this was: Code 1 - Normal distribution (most common; tax-free if used for qualified medical expenses). Code 2 - Excess contributions. Code 3 - Disability. Code 4 - Death distribution (same year). Code 5 - Prohibited transaction. Code 6 - Death distribution to nonspouse beneficiary after year of death. The code determines how the distribution is taxed.
Box 4 - FMV on Date of Death:
Only applies if the account holder died. Shows the fair market value of the account on the date of death. Important for beneficiaries: for a nonspouse beneficiary, the FMV is includible in income. For a surviving spouse who becomes the new account holder, the FMV establishes the account's basis. Any earnings after the date of death (Box 1 minus Box 4) are taxable.
Box 5 - Checkbox (HSA, Archer MSA, or MA MSA):
A simple checkbox indicating which type of account the distribution came from. Check only one. This determines which tax form the account holder uses: Form 8889 for HSAs, Form 8853 for Archer MSAs and Medicare Advantage MSAs. A separate 1099-SA is required for each account type if the recipient holds more than one.
WHAT IS FORM 1099-SA?
What Is Form 1099-SA and Who Needs to File It?
IRS Form 1099-SA, officially called "Distributions From an HSA, Archer MSA, or Medicare Advantage MSA," reports every dollar that came out of a tax-advantaged medical savings account during the year. It tells the IRS how much was distributed, what type of distribution it was, and which account it came from. The form doesn't determine whether the distribution is taxable. That's your job when you file your return.
Unlike account statements from your HSA provider (which show transactions), Form 1099-SA is the official IRS information return that connects your distributions to your tax filing. HSA distributions are reported on Form 8889, while Archer MSA and Medicare Advantage MSA distributions are reported on Form 8853. The numbers on your 1099-SA must match what you report, or the IRS flags the discrepancy.
If any of the following describe your situation, a 1099-SA is either being issued to you or you need to issue one: You're a financial institution, bank, credit union, or insurance company that serves as trustee or custodian of HSA, Archer MSA, or Medicare Advantage MSA accounts. You're an account holder who withdrew funds from your HSA. You took a distribution that wasn't for a qualified medical expense. You withdrew excess contributions and their earnings before your tax filing deadline. You're a beneficiary who received distributions after the account holder's death. The distribution codes in Box 3, the taxability rules, and the connection to Forms 8889 and 8853 trip people up—that's where Simplicity AI comes in.
How to Fill Out Form 1099-SA Online Using Simplicity AI
1
Upload your 1099-SA PDF to Simplicity AI. The AI scans the form, detects all fields from payer information through Box 5, and converts them into a guided questionnaire.
2
Enter your institution's details: legal name, address, phone number, and EIN. If you've filled out other forms on Simplicity AI, your trustee information carries over.
3
Enter the account holder's name, TIN, and address. Upload account records as a source document and Simplicity AI pulls the recipient details into the correct fields.
4
Enter the gross distribution amount in Box 1 and any earnings on excess contributions in Box 2. Simplicity AI keeps the two amounts separate so you don't accidentally double-count earnings.
5
Select the correct distribution code in Box 3. Simplicity AI explains each one in plain English: normal distribution, excess contributions, disability, death distribution, prohibited transaction, or death distribution to a nonspouse beneficiary.
6
Check the account type in Box 5 (HSA, Archer MSA, or MA MSA), review every field for accuracy, and export your completed 1099-SA as a clean PDF. Filing for multiple account holders? Jump straight into the next form with your trustee details already saved.
Super Fast
One 1099-SA takes under a minute. Filing for dozens or hundreds of account holders? Upload records as source documents and auto-fill each form back-to-back.
AI-Powered
Simplicity AI understands the 1099-SA structure, from distribution codes to account-type checkboxes. It maps your answers to the correct fields and flags common errors before you export.
Secure
Your 1099-SA forms contain account holder SSNs, distribution amounts, and medical savings account details. Documents are encrypted, handled privately, and never shared.
FAQs
Frequently Asked Questions About Form 1099-SA
What is Form 1099-SA, and why did I receive one?
Form 1099-SA reports distributions taken from your Health Savings Account (HSA), Archer MSA, or Medicare Advantage MSA during the tax year. If you withdrew any money from one of these accounts, your account trustee is required to send you this form. It shows how much came out and the distribution type.
How do I fill out a 1099-SA online for free?
Upload your 1099-SA PDF to Simplicity AI for free. The platform converts it into a guided, interactive form that walks you through each field in plain English. Enter your trustee details, account holder information, distribution amount, and distribution code. Review, then export a clean PDF ready for filing.
What do the distribution codes in Box 3 mean?
Box 3 tells the IRS what kind of distribution was made. Code 1 is a normal distribution (tax-free when used for qualified medical expenses). Code 2 means excess contributions were returned. Code 3 applies to distributions after the account holder became disabled. Code 4 is a death distribution in the year of death. Code 5 means a prohibited transaction. Code 6 is a death distribution to a nonspouse beneficiary after the year of death.
Are all HSA distributions taxable?
No. Distributions used to pay for qualified medical expenses are completely tax-free. Only distributions used for non-qualified expenses are taxable, and they also trigger an additional 20% penalty tax unless you're 65 or older, disabled, or deceased. The 1099-SA itself doesn't tell you whether your distribution is taxable; you determine that on Form 8889.
What's the difference between Form 1099-SA and Form 5498-SA?
Form 1099-SA reports money coming out of your account (distributions). Form 5498-SA reports money going into your account (contributions and rollovers), plus the fair market value at year-end. Your trustee files both: 1099-SA is due by January 31, while 5498-SA is due by June 2.
Do I need to file Form 8889 or Form 8853 with my tax return?
If you received distributions from an HSA, you must file Form 8889 with your Form 1040. For Archer MSA or Medicare Advantage MSA distributions, use Form 8853 instead. The numbers from your 1099-SA feed directly into these forms.
What happens if I contribute too much to my HSA?
If you exceeded the annual contribution limit and withdrew the excess (plus earnings) before your tax filing deadline, your trustee reports the earnings in Box 2 and uses distribution code 2 in Box 3. Those earnings are taxable. If you don't withdraw the excess in time, the IRS imposes a 6% excise tax on the excess amount for every year it remains in the account.
Is my data secure when I complete Form 1099-SA in Simplicity AI?
Your 1099-SA contains account holder SSNs, distribution amounts, and medical savings account details. Simplicity AI encrypts your documents, handles them privately, and never shares your data or uses it for AI training. You control who sees what.
Common Mistakes When Filing Form 1099-SA
(and How AI Prevents Them)
Using the Wrong Distribution Code in Box 3
Each distribution code carries a different tax treatment. Entering Code 1 when the distribution was actually a return of excess contributions (Code 2) misrepresents the tax situation. Simplicity AI describes each code in plain English and asks what happened with the distribution, so the correct code is selected automatically.
Reporting Trustee-to-Trustee Transfers as Distributions
When funds move directly from one HSA to another (or one MSA to another) through a trustee-to-trustee transfer, it is not a reportable distribution. No 1099-SA should be filed. Simplicity AI flags this distinction during the guided flow, so transfers don't end up on forms where they don't belong.
Including Excess Employer Contributions in Box 1
If an employer's HSA contributions exceeded the annual limit and those excess amounts (plus earnings) are returned to the employer, they should not be reported in Box 1. Simplicity AI asks whether the distribution involves returned employer contributions and excludes them from Box 1 when applicable.
Leaving Box 2 Blank When Excess Contributions Were Returned
If the account holder withdrew excess contributions before the tax deadline, Box 2 must show the earnings generated by those excess amounts. Many trustees report the withdrawal in Box 1 but forget Box 2. Simplicity AI prompts for Box 2 whenever the distribution code is set to Code 2 (excess contributions).
Checking the Wrong Account Type in Box 5
Box 5 has three checkboxes: HSA, Archer MSA, and MA MSA. Selecting the wrong option redirects the account holder to the wrong tax form (8889 vs. 8853). Simplicity AI locks the account type to one selection per form and requires a separate 1099-SA if the recipient holds more than one account type.
Omitting Box 4 When the Account Holder Died
If the account holder died during the year, Box 4 must show the fair market value of the account on the date of death. Omitting Box 4 leaves the beneficiary without the information they need to file correctly. Simplicity AI asks whether the account holder is deceased and requires Box 4 when death-related distribution codes (4 or 6) are selected.
Filing One 1099-SA for Multiple Account Types
If a recipient holds both an HSA and an Archer MSA with the same trustee, each account type requires its own separate 1099-SA. Simplicity AI enforces one account type per form and prompts you to create additional forms when multiple account types exist for the same recipient.
Mismatched TIN Between 1099-SA and Account Records
The recipient's TIN on the 1099-SA must match the IRS's records. If the account was opened with an SSN but the trustee enters an ITIN (or transposes a digit), the IRS flags the discrepancy. Simplicity AI validates that the TIN matches the recipient shown on the form and flags potential mismatches before you export.
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