Form 8889 — Health Savings Accounts (HSAs)

Official source: IRS Forms, Instructions & Publications (https://www.irs.gov/pub/irs-pdf/f8889.pdf), retrieved 2026-10-03. U.S. Government work (17 U.S.C. § 105).

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Form

Department of the Treasury Internal Revenue Service

Attach to Form 1040, 1040-SR, or 1040-NR. Go to www.irs.gov/Form8889 for instructions and the latest information.

OMB No. 1545-0074

Attachment Sequence No. 52

Name(s) shown on Form 1040, 1040-SR, or 1040-NR Social security number of HSA beneficiary. If both spouses have HSAs, see instructions.

Before you begin: Complete Form 8853, Archer MSAs and Long-Term Care Insurance Contracts, if required.

Part I HSA Contributions and Deduction. See the instructions before completing this part. If you are filing jointly and both you and your spouse each have separate HSAs, complete a separate Part I for each spouse.

1 Check the box to indicate your coverage under a high-deductible health plan (HDHP) during 2025.

complete a separate Part III for each spouse.

18 Last-month rule . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 19 Qualified HSA funding distribution . . . . . . . . . . . . . . . . . . . . . . . 19 20 Total income. Add lines 18 and 19. Include this amount on Schedule 1 (Form 1040), Part I, line 8f . 20 21 Additional tax. Multiply line 20 by 10% (0.10). Include this amount in the total on Schedule 2 (Form 1040), Part II, line 17d . . . . . . . . . . . . . . . . . . . . . . . . . . . 21

For Paperwork Reduction Act Notice, see your tax return instructions. Cat. No. 37621P Form 8889 (2025) Created 3/28/25