Form 8853 - Archer MSAs and Long-Term Care Insurance Contracts
Use Form 8853 to:

  • Report Archer MSA contributions (including employer contributions),

  • Figure your Archer MSA deduction,

  • Report distributions from Archer MSAs or Medicare Advantage MSAs,

  • Report taxable payments from long-term care (LTC) insurance contracts, or

  • Report taxable accelerated death benefits from a life insurance policy.

Who Must File:

You must file Form 8853 if any of the following applies:

  • You (or your employer) made contributions for 2006 to your Archer MSA.

  • You are filing a joint return and your spouse (or his or her employer) made contributions for 2006 to your spouse's Archer MSA.

  • You (or your spouse, if filing jointly) received Archer MSA or Medicare Advantage MSA distributions in 2006.

  • You acquired an interest in an Archer MSA or a Medicare Advantage MSA because of the death of the account holder.

  • You (or your spouse, if filing jointly) were a policyholder who received payments under an LTC insurance contract or received any accelerated death benefits from a life insurance policy on a per diem or other periodic basis in 2006.