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1099-SA Box 1 Gross Distribution: What It Includes

Updated September 29, 2026. Quick answer: Box 1 of Form 1099-SA is the total amount that came out of the account during the year. It is a gross figure. The IRS tells the payer it is not required to work out the taxable amount, so Box 1 is not the same thing as taxable income.

Form 8606 and Form 8889 for 2025, read line by line: Form 8889 lines 14a to 14c, Form 8889 lines 15 and 16 and Form 8889 lines 17a and 17b.

What goes in Box 1

The IRS instruction to the payer reads: “Enter the total amount of the distribution. Include any earnings separately reported in box 2.” It continues: “You are not required to determine the taxable amount of a distribution.” The 1099-SA instructions read here carry the edition label Rev. December 2026 (the IRS file is dated 22-Dec-2025). A payment sent straight to a medical provider still counts, because the same instructions say the distribution “may have been paid directly to a medical service provider or to the account holder”.

What the payer leaves out of Box 1

The instructions list three items with the sentence “Do not report the following in box 1.” They are “A negative amount.”, “The withdrawal of excess employer contributions (and the earnings on them) returned to an employer as a distribution from an employee’s HSA.”, and “Excess MA MSA contributions returned to the Secretary of Health and Human Services or their representative.”

Box 2 is narrower than it looks

Box 2 is not a general earnings box. The instructions say: “Enter the total earnings distributed with any excess HSA or Archer MSA contributions returned by the due date of the account holder’s tax return. Include this amount in box 1. Report earnings on other distributions only in box 1.” A Box 2 amount goes with distribution code 2 in Box 3, described on the Box 3 codes page.

A distribution taken by mistake

For an HSA, the instructions say the account beneficiary “may repay the mistaken distribution no later than the due date of the tax return (not counting extensions) following the first year the account beneficiary knew or should have known the distribution was a mistake.” They add that “the mistaken distribution is not included in gross income, is not subject to the additional 20% tax, and the repayment is not subject to the excise tax on excess contributions.” The payer is not required to allow the return: “you do not have to allow beneficiaries to return a mistaken distribution to the HSA.”

Box 5, the account type checkbox

Box 5 tells you which kind of account the money came from. The instruction is “Check the box to indicate if this distribution was from an HSA, Archer MSA, or MA MSA.”

Common mistakes

  • Entering the Box 1 total as taxable income. The instructions say the payer is not required to determine the taxable amount.
  • Looking for Box 2 to show all the earnings. It covers earnings on returned excess contributions only.
  • Assuming a mistaken distribution can always be returned. The instructions say the payer does not have to allow it.

Related: 1099-SA Box 3 Distribution Codes 1 to 6 Explained, 1099-SA Box 4: FMV on Date of Death (Inherited HSA), the HSA contribution limits, and how an excess HSA contribution gets fixed.

Every box in one place: the 1099-SA and 1099-Q boxes table. If your withdrawal came from an IRA or 401(k), see the Form 1099-R Box 7 codes.

Figures verified against the IRS Instructions for Forms 1099-SA and 5498-SA (Rev. December 2026), the IRS Instructions for Form 1099-Q (Rev. April 2025) and the IRS About Form 1099-SA and 1099-Q pages on September 30, 2026.

Sources

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Source: the IRS instructions for the filer of each form, read at irs.gov on September 29, 2026. General information, not tax advice. Your own facts decide the outcome, and a preparer, the account provider or the IRS is the right place to confirm anything consequential.