U.S. · Tax forms
1099-SA box 1 gross distribution.
The total paid out is the starting point. Qualified medical expenses are what get it off your tax bill.
Box 1 is the total amount paid out of your HSA, Archer MSA or MA MSA. The trustee does not work out what is taxable. You do that on Form 8889: line 14a is your box 1 total, less rollovers and withdrawn excess contributions (14b), less qualified medical expenses paid from the HSA (line 15). What is left is taxable and generally carries an additional 20% tax unless you were 65, disabled, or the account owner died.
Estimate the taxable part of a distribution
Result
Where each 1099-SA box goes
| Box | What the trustee reports | What to do |
|---|---|---|
| Box 1 | Total distribution, including earnings separately shown in box 2. Not a negative amount. The trustee does not figure the taxable amount. | Form 8889 line 14a for an HSA. |
| Box 2 | Earnings on excess contributions returned by the due date of the return. Included in box 1. | Taxable as other income; tied to distribution code 2. |
| Box 3 | Distribution code. | See the 1099-SA distribution codes. |
| Box 4 | Fair market value on the date of death. | Only after the owner dies. |
| Box 5 | Checkbox for the account type: HSA, Archer MSA or MA MSA. | Confirms which Form 8889 part applies. |
| Line 14b | Rollovers and withdrawn excess contributions on line 14a. | Subtracted before taxable income is figured. |
| Line 15 | Distributions used to pay qualified medical expenses not reimbursed by insurance. | Reduces the taxable amount. Cannot also be deducted on Schedule A. |
| Lines 17a and 17b | Additional 20% tax on taxable amounts unless the account holder died, became disabled or turned 65. | Schedule 2, line 17c. |
Box 1 versus your taxable amount
The 1099-SA instructions say the trustee is not required to determine the taxable amount of a distribution. Form 8889 does it. Line 14c is line 14a minus line 14b. Line 16, taxable HSA distributions, is line 15 subtracted from line 14c, never below zero, and is included on Schedule 1 (Form 1040), Part I, line 8f. Line 17b is 20% of the part of line 16 that does not meet an exception. For example, with $4,000 in box 1, $500 rolled over, and $2,800 of qualified expenses, line 14c is $3,500, line 16 is $700 and the 20% tax is $140 unless an exception applies.
What counts as a qualified medical expense
The Form 8889 instructions say line 15 includes only distributions used to pay qualified medical expenses not reimbursed by insurance or other coverage that were incurred after the HSA was established. Expenses of you, your spouse and your dependents all count. You cannot take a Schedule A deduction for any amount you include on line 15. The instructions also warn that a distribution of excess contributions taken after the due date does not qualify even if used for medical expenses.
Box 1 can be wrong
Box 1 includes everything paid out, including amounts you rolled over to another HSA and excess contributions you withdrew (their earnings are also shown in box 2). That is why Form 8889 line 14b exists. If the form is plainly incorrect, ask the trustee for a corrected form. Keep receipts for the qualified medical expenses in case of a question later.
Where next
Contributions side: 5498-SA box 2. For limits see the HSA contribution limit calculator.
Sources
- Instructions for Forms 1099-SA and 5498-SA: Box 1, Gross Distribution; Boxes 2 to 5.. Read November 2, 2026. (IRS page last reviewed April 30, 2026.)
- Instructions for Form 8889 (2025): Part II, lines 14a, 14b, 15, 17a and 17b; Exceptions to the Additional 20% Tax.. Read November 2, 2026. (IRS page last reviewed April 30, 2026.)
- Form 8889 (2025): Lines 14c and 16 as printed on the form.. Read November 2, 2026. (Part II, lines 14a to 17b.)
Line and box numbers are those printed in the IRS instructions named above and can change from year to year; match each box by its label.
Frequently asked questions
What is box 1 on a 1099-SA?
Box 1 is the total amount distributed from your HSA, Archer MSA or MA MSA during the year, before any taxable amount is figured.
Is 1099-SA box 1 taxable?
Not by itself. Distributions used for qualified medical expenses are not taxable. You figure the taxable part on Form 8889.
Where does 1099-SA box 1 go on my return?
For an HSA it goes on Form 8889 line 14a. The taxable amount from line 16 then goes to Schedule 1, line 8f.
What is the 20% additional tax?
HSA distributions included in income are subject to an additional 20% tax unless you died, became disabled or turned 65 before the distribution.
Do I enter rollovers on line 15?
No. Rollovers and withdrawn excess contributions go on line 14b. Line 15 is for qualified medical expenses.
Not tax advice
This page summarizes IRS instructions, mostly written for the people who prepare the form, and is not tax, legal or financial advice. The payer, a CPA or an enrolled agent can confirm what a box or code means for your return. Everything runs in your browser; nothing you enter is sent anywhere.