Federal Tax Form 8853 - Archer MSAs and LTC Insurance Contracts

Tax Form 8853 is used 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

You must file Form 8853 if any following applies:

  • You (or your employer) made contributions for 2005 to your Archer MSA
  • You are filing a joint return and your spouse (or his or her employer) made contributions for 2005 to your spouse's Archer MSA
  • You (or your spouse, if filing jointly) received Archer MSA or Medicare Advantage MSA distributions in 2005
  • 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 2005


Form name Instructions Form
2007 Federal Tax Form 8853 - Archer MSAs and LTC Insurance Contracts
2006 Federal Tax Form 8853 - Archer MSAs and LTC Insurance Contracts -
2005 Federal Tax Form 8853 - Archer MSAs and LTC Insurance Contracts -


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