Skip to content
ChatProjectCodes

Federal housing law

2025 Form 8853 (PDF)

Federal housing law as enacted — verbatim and citable.

Edition
2026-10-03
Last updated
2026-10-04
Jurisdiction
United States
Ask AI about this codeSearch the library

Official source: IRS Forms, Instructions & Publications (https://www.irs.gov/pub/irs-pdf/f8853.pdf), retrieved 2026-10-03. U.S. Government work (17 U.S.C. § 105).

Form

8853

Form Department of the Treasury Go to www.irs.gov/Form8853 Long-Term Care Insurance…

Internal Revenue Service Attach to Form 1040, 1040-SR, or 1040-NR. Sequence No. 39

Name(s) shown on return Social security number of MSA account holder. If both spouses have MSAs, see instructions. Section A. Archer MSAs. If you have only a Medicare Advantage MSA, skip Section A and complete Section B.

Department of the Treasury Internal Revenue Service

Exceptions & meaning →

Archer MSAs and Long-Term Care Insurance Contracts

Go to www.irs.gov/Form8853 for instructions and the latest information.

Attach to Form 1040, 1040-SR, or 1040-NR.

Part I Archer MSA Contributions and Deductions. See instructions before completing this part. If you are filing jointly and both you and your spouse have high deductible health plans with self-only coverage, complete a separate Part I for each spouse.

distributions in 2025 from a Medicare Advantage MSA, complete a separate Section B for each spouse. See instructions.

Form 8853 (2025) Attachment Sequence No. 39 Page 2

Name of policyholder (as shown on return) Social security number of policyholder Section C. Long-Term Care (LTC) Insurance Contracts. See Filing Requirements for Section C in the instructions

before completing this section. If more than one Section C is attached, check here . . . . . . . . . . . . . . . . . . . . . . .

14a Name of insured b Social security number of insured 15 In 2025, did anyone other than you receive payments on a per diem or other periodic basis under a qualified

LTC insurance contract covering the insured or receive accelerated death benefits under a life insurance policy covering the insured? . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes No 16 Was the insured a terminally ill individual? . . . . . . . . . . . . . . . . . . . . . . Yes No Note: If “Yes” and the only payments you received in 2025 were accelerated death benefits that were paid to you because the insured was terminally ill, skip lines 17 through 25 and enter -0- on line 26.

17 Gross LTC payments received on a per diem or other periodic basis. Enter the total of the amounts
from box 1 of all Forms 1099-LTC you received with respect to the insured on which the “Per diem”
box in box 3 is checked . . . . . . . . . . . . . . . . . . . . . . . . . .
Caution: Don’t use lines 18 through 26 to figure the taxable amount of benefits paid under an LTC
insurance contract that isn’t a qualified LTC insurance contract. Instead, if the benefits aren’t
excludable from your income (for example, if the benefits aren’t paid for personal injuries or sickness
through accident or health insurance), report the amount not excludable as income on Schedule 1
(Form 1040), line 8e, or, for taxpayers filing Form 1040-NR, on Schedule NEC (Form 1040-NR), line 12.
18 Enter the part of the amount on line 17 that is from qualified LTC insurance contracts . . . . .
19 Accelerated death benefits received on a per diem or other periodic basis. Don’t include any amounts
you received because the insured was terminally ill. See instructions . . . . . . . . . . .
20 Add lines 18 and 19 . . . . . . . . . . . . . . . . . . . . . . . . . . .
Note: If you checked “Yes” on line 15 above, see Multiple Payees in the
instructions before completing lines 21 through 25.
21 Multiply $420 by the number of days in the LTC period . . . . . . . . 21
22 Costs incurred for qualified LTC services provided for the insured during the
LTC period (see instructions) . . . . . . . . . . . . . . . . 22
23 Enter the larger of line 21 or line 22 . . . . . . . . . . . . . . 23
24 Reimbursements for qualified LTC services provided for the insured during the
LTC period . . . . . . . . . . . . . . . . . . . . . . 24
Caution: If you received any reimbursements from LTC contracts issued before August 1, 1996, see
instructions.
25 Per diem limitation. Subtract line 24 from line 23 . . . . . . . . . . . . . . . . . .
26 Taxable payments. Subtract line 25 from line 20. If zero or less, enter -0-. Also include this amount in
the total on Schedule 1 (Form 1040), line 8e, or, for taxpayers filing Form 1040-NR, on Schedule NEC
(Form 1040-NR), line 12. For taxpayers filing Form 1040-NR, on Schedule NEC (Form 1040-NR), line
12, enter “LTC” and the amount . . . . . . . . . . . . . . . . . . . . . . .		 17
17

Gross LTC payments received on a per diem or other periodic basis. Enter the total of the amounts
from box 1 of all Forms 1099-LTC you received with respect to the insured on which the “Per diem”
box in box 3 is checked .
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
Caution: Don’tuse lines 18 through 26 to figure the taxable amount of benefits paid under an LTC
insurance contract that isn’t aqualified LTC insurance contract. Instead, if the benefits aren’t
excludable from your income (for example, if the benefits aren’t paid for personal injuries or sickness
through accident or health insurance), report the amount not excludable as income on Schedule 1
(Form 1040), line 8e, or, for taxpayers filing Form 1040-NR, on Schedule NEC (Form 1040-NR), line 12.
18
Enter the part of the amount on line 17 that is fromqualifiedLTC insurance contracts
.
.
.
.
.
19
Accelerated death benefits received on a per diem or other periodic basis. Don’t include any amounts
you received because the insured was terminally ill. See instructions
.
.
.
.
.
.
.
.
.
.
.
20
Add lines 18 and 19
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
Note:If you checked “Yes” on line 15 above, seeMultiple Payees in the
instructions before completing lines 21 through 25.
21
Multiply $420 by the number of days in the LTC period .
.
.
.
.
.
.
.
21
22
Costs incurred for qualified LTC services provided for the insured during the
LTC period (see instructions)
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
22
23
Enter thelargerof line 21 or line 22 .
.
.
.
.
.
.
.
.
.
.
.
.
.
23
24
Reimbursements for qualified LTC services provided for the insured during the
LTC period
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
24
**Caution:**If you received any reimbursements from LTC contracts issued before August 1, 1996, see
instructions.
25
Per diem limitation. Subtract line 24 from line 23 .
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
26


**Taxable payments.**Subtract line 25 from line 20. If zero or less, enter -0-. Also include this amount in
the total on Schedule 1 (Form 1040), line 8e, or, for taxpayers filing Form 1040-NR, on Schedule NEC
(Form 1040-NR), line 12. For taxpayers filing Form 1040-NR, on Schedule NEC (Form 1040-NR), line
12, enter “LTC” and the amount
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.		 18
17

Gross LTC payments received on a per diem or other periodic basis. Enter the total of the amounts
from box 1 of all Forms 1099-LTC you received with respect to the insured on which the “Per diem”
box in box 3 is checked .
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
Caution: Don’tuse lines 18 through 26 to figure the taxable amount of benefits paid under an LTC
insurance contract that isn’t aqualified LTC insurance contract. Instead, if the benefits aren’t
excludable from your income (for example, if the benefits aren’t paid for personal injuries or sickness
through accident or health insurance), report the amount not excludable as income on Schedule 1
(Form 1040), line 8e, or, for taxpayers filing Form 1040-NR, on Schedule NEC (Form 1040-NR), line 12.
18
Enter the part of the amount on line 17 that is fromqualifiedLTC insurance contracts
.
.
.
.
.
19
Accelerated death benefits received on a per diem or other periodic basis. Don’t include any amounts
you received because the insured was terminally ill. See instructions
.
.
.
.
.
.
.
.
.
.
.
20
Add lines 18 and 19
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
Note:If you checked “Yes” on line 15 above, seeMultiple Payees in the
instructions before completing lines 21 through 25.
21
Multiply $420 by the number of days in the LTC period .
.
.
.
.
.
.
.
21
22
Costs incurred for qualified LTC services provided for the insured during the
LTC period (see instructions)
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
22
23
Enter thelargerof line 21 or line 22 .
.
.
.
.
.
.
.
.
.
.
.
.
.
23
24
Reimbursements for qualified LTC services provided for the insured during the
LTC period
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
24
**Caution:**If you received any reimbursements from LTC contracts issued before August 1, 1996, see
instructions.
25
Per diem limitation. Subtract line 24 from line 23 .
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
26


**Taxable payments.**Subtract line 25 from line 20. If zero or less, enter -0-. Also include this amount in
the total on Schedule 1 (Form 1040), line 8e, or, for taxpayers filing Form 1040-NR, on Schedule NEC
(Form 1040-NR), line 12. For taxpayers filing Form 1040-NR, on Schedule NEC (Form 1040-NR), line
12, enter “LTC” and the amount
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.		 19
17

Gross LTC payments received on a per diem or other periodic basis. Enter the total of the amounts
from box 1 of all Forms 1099-LTC you received with respect to the insured on which the “Per diem”
box in box 3 is checked .
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
Caution: Don’tuse lines 18 through 26 to figure the taxable amount of benefits paid under an LTC
insurance contract that isn’t aqualified LTC insurance contract. Instead, if the benefits aren’t
excludable from your income (for example, if the benefits aren’t paid for personal injuries or sickness
through accident or health insurance), report the amount not excludable as income on Schedule 1
(Form 1040), line 8e, or, for taxpayers filing Form 1040-NR, on Schedule NEC (Form 1040-NR), line 12.
18
Enter the part of the amount on line 17 that is fromqualifiedLTC insurance contracts
.
.
.
.
.
19
Accelerated death benefits received on a per diem or other periodic basis. Don’t include any amounts
you received because the insured was terminally ill. See instructions
.
.
.
.
.
.
.
.
.
.
.
20
Add lines 18 and 19
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
Note:If you checked “Yes” on line 15 above, seeMultiple Payees in the
instructions before completing lines 21 through 25.
21
Multiply $420 by the number of days in the LTC period .
.
.
.
.
.
.
.
21
22
Costs incurred for qualified LTC services provided for the insured during the
LTC period (see instructions)
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
22
23
Enter thelargerof line 21 or line 22 .
.
.
.
.
.
.
.
.
.
.
.
.
.
23
24
Reimbursements for qualified LTC services provided for the insured during the
LTC period
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
24
**Caution:**If you received any reimbursements from LTC contracts issued before August 1, 1996, see
instructions.
25
Per diem limitation. Subtract line 24 from line 23 .
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
26


**Taxable payments.**Subtract line 25 from line 20. If zero or less, enter -0-. Also include this amount in
the total on Schedule 1 (Form 1040), line 8e, or, for taxpayers filing Form 1040-NR, on Schedule NEC
(Form 1040-NR), line 12. For taxpayers filing Form 1040-NR, on Schedule NEC (Form 1040-NR), line
12, enter “LTC” and the amount
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.		 20
17

Gross LTC payments received on a per diem or other periodic basis. Enter the total of the amounts
from box 1 of all Forms 1099-LTC you received with respect to the insured on which the “Per diem”
box in box 3 is checked .
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
Caution: Don’tuse lines 18 through 26 to figure the taxable amount of benefits paid under an LTC
insurance contract that isn’t aqualified LTC insurance contract. Instead, if the benefits aren’t
excludable from your income (for example, if the benefits aren’t paid for personal injuries or sickness
through accident or health insurance), report the amount not excludable as income on Schedule 1
(Form 1040), line 8e, or, for taxpayers filing Form 1040-NR, on Schedule NEC (Form 1040-NR), line 12.
18
Enter the part of the amount on line 17 that is fromqualifiedLTC insurance contracts
.
.
.
.
.
19
Accelerated death benefits received on a per diem or other periodic basis. Don’t include any amounts
you received because the insured was terminally ill. See instructions
.
.
.
.
.
.
.
.
.
.
.
20
Add lines 18 and 19
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
Note:If you checked “Yes” on line 15 above, seeMultiple Payees in the
instructions before completing lines 21 through 25.
21
Multiply $420 by the number of days in the LTC period .
.
.
.
.
.
.
.
21
22
Costs incurred for qualified LTC services provided for the insured during the
LTC period (see instructions)
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
22
23
Enter thelargerof line 21 or line 22 .
.
.
.
.
.
.
.
.
.
.
.
.
.
23
24
Reimbursements for qualified LTC services provided for the insured during the
LTC period
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
24
**Caution:**If you received any reimbursements from LTC contracts issued before August 1, 1996, see
instructions.
25
Per diem limitation. Subtract line 24 from line 23 .
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
26


**Taxable payments.**Subtract line 25 from line 20. If zero or less, enter -0-. Also include this amount in
the total on Schedule 1 (Form 1040), line 8e, or, for taxpayers filing Form 1040-NR, on Schedule NEC
(Form 1040-NR), line 12. For taxpayers filing Form 1040-NR, on Schedule NEC (Form 1040-NR), line
12, enter “LTC” and the amount
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.		 25
17

Gross LTC payments received on a per diem or other periodic basis. Enter the total of the amounts
from box 1 of all Forms 1099-LTC you received with respect to the insured on which the “Per diem”
box in box 3 is checked .
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
Caution: Don’tuse lines 18 through 26 to figure the taxable amount of benefits paid under an LTC
insurance contract that isn’t aqualified LTC insurance contract. Instead, if the benefits aren’t
excludable from your income (for example, if the benefits aren’t paid for personal injuries or sickness
through accident or health insurance), report the amount not excludable as income on Schedule 1
(Form 1040), line 8e, or, for taxpayers filing Form 1040-NR, on Schedule NEC (Form 1040-NR), line 12.
18
Enter the part of the amount on line 17 that is fromqualifiedLTC insurance contracts
.
.
.
.
.
19
Accelerated death benefits received on a per diem or other periodic basis. Don’t include any amounts
you received because the insured was terminally ill. See instructions
.
.
.
.
.
.
.
.
.
.
.
20
Add lines 18 and 19
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
Note:If you checked “Yes” on line 15 above, seeMultiple Payees in the
instructions before completing lines 21 through 25.
21
Multiply $420 by the number of days in the LTC period .
.
.
.
.
.
.
.
21
22
Costs incurred for qualified LTC services provided for the insured during the
LTC period (see instructions)
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
22
23
Enter thelargerof line 21 or line 22 .
.
.
.
.
.
.
.
.
.
.
.
.
.
23
24
Reimbursements for qualified LTC services provided for the insured during the
LTC period
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
24
**Caution:**If you received any reimbursements from LTC contracts issued before August 1, 1996, see
instructions.
25
Per diem limitation. Subtract line 24 from line 23 .
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
26


**Taxable payments.**Subtract line 25 from line 20. If zero or less, enter -0-. Also include this amount in
the total on Schedule 1 (Form 1040), line 8e, or, for taxpayers filing Form 1040-NR, on Schedule NEC
(Form 1040-NR), line 12. For taxpayers filing Form 1040-NR, on Schedule NEC (Form 1040-NR), line
12, enter “LTC” and the amount
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.		 26

Form 8853 (2025)

Exceptions & meaning →

GoCodebook provides public access, search, citation, multilingual explanation, and practical interpretation of legally adopted building regulations. It is not a substitute for the official ICC or California code publications.