Form 8889 Generator by Jotform
If you had a health savings account this year, you probably need Form 8889 to report contributions and withdrawals. Fill it out online for free with Jotform and download a ready-to-attach PDF.
Your health account details stay private
Form 8889 includes your SSN and account activity. Jotform protects your data with 256-bit SSL encryption and GDPR and CCPA friendly features, and you can switch on encrypted forms for added security.
Fill out Form 8889 on any device
Have your HSA statement open on your computer and the form on your phone? That works. Jotform's forms respond to any screen, so you can fill out Form 8889 on a desktop, tablet, or mobile device.
Simple to fill, quick to download
Jotform breaks Form 8889 into easy fields so you can enter contributions and distributions without guessing. When you're finished, download it as a PDF in seconds.
Returned in the official IRS format
Everything you enter is placed back into the original Form 8889 layout. Your PDF matches the IRS version, so you can attach it to your Form 1040 or pass it to your tax preparer.
FAQ
What is Form 8889?
Form 8889, Health Savings Accounts (HSAs), is the form you use to report money that went into and out of your HSA during the year. It's also where you figure your HSA deduction and any income or additional tax you might owe. You attach it to your Form 1040.
Who needs to file Form 8889?
You generally need to file Form 8889 if you or anyone else, including your employer, contributed to your HSA, if you took a distribution from your HSA, or if you have to include certain amounts in income because you stopped being an eligible individual. You also file it if you inherited an HSA.
If you and your spouse each have an HSA, each of you files a separate Form 8889.
What happens if I use HSA money for nonqualified expenses?
Distributions not used for qualified medical expenses are generally included in your income and may also be subject to a 20% additional tax. Exceptions can apply, for example if you're 65 or older or disabled. Part II of Form 8889 is where you work this out.
How do I fill out Form 8889?
Enter your name and SSN, then work through Part I to report contributions made by you and by your employer and to figure your HSA deduction. You'll need to know whether you had self-only or family coverage under a high-deductible health plan.
In Part II, report total distributions and how much went to qualified medical expenses. Use Part III only if you didn't stay eligible during a testing period and need to add amounts to income.
Where do I find the numbers for Form 8889?
Your HSA trustee sends Form 1099-SA for distributions and Form 5498-SA for contributions. Employer contributions usually appear in box 12 of your Form W-2 with code W. Contribution limits change each year, so check the current instructions before you fill out Part I.
Is my information safe when I fill out Form 8889 with Jotform?
Yes. Jotform uses 256-bit SSL encryption and secure servers, and you can enable encrypted forms for extra privacy. You can fill out Form 8889 and download the PDF for free.
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