How to Fill Out IRS Form 8853 (w/Examples) + FAQs

You file IRS Form 8853 to report Archer MSA contributions, Archer MSA distributions, Medicare Advantage MSA distributions, and taxable payments from long-term care (LTC) insurance contracts or accelerated death benefits. You attach it to your Form 1040, Form 1040-SR, or Form 1040-NR for the tax year the activity occurred, and you complete only the sections that match what happened during the year.

Failing to file Form 8853 when required can trigger a 20% additional tax on non-qualified MSA distributions, push otherwise tax-free LTC benefits into your taxable income, and invite IRS notices that compound interest and penalties. According to the IRS Statistics of Income, fewer than 50,000 returns claim Archer MSA activity in a typical year, which means the form is unfamiliar to most preparers and software prompts often miss the nuances that decide whether a distribution is tax-free.

Here is what this guide gives you:

• 📋 A line-by-line walkthrough of every section (A, B, C, and D) on Form 8853 with the math, the elections, and the consequences of each choice.
• 💡 Three named real-world examples covering self-employed Archer MSA contributors, Medicare Advantage MSA retirees, and families receiving accelerated death benefits.
• ⚠️ A “Mistakes to Avoid” section that catches the seven errors that most often turn tax-free benefits into taxable income.
• 🏛️ Federal rules first, with state nuances for California, New Jersey, Alabama, and other non-conforming states that quietly tax these accounts.
• ✅ Ten plus FAQs that answer the audit-bait questions about per-diem LTC limits, terminally ill versus chronically ill status, excess contributions, and the 20% penalty.

What Is IRS Form 8853 and Who Must File It

IRS Form 8853, titled “Archer MSAs and Long-Term Care Insurance Contracts,” is the federal tax form that reconciles four narrow but consequential tax events. The form exists because Congress carved out tax-favored treatment for medical savings vehicles and certain insurance payouts under Internal Revenue Code §220, §138, §7702B, and §101(g). Each of these code sections allows money to flow tax-free only when you prove eligibility on Form 8853.

You must file Form 8853 if you (or your spouse, if filing jointly) did any of the following during the tax year. You contributed to an Archer Medical Savings Account (MSA), or your employer contributed on your behalf. You received a distribution from an Archer MSA or a Medicare Advantage MSA. You received payments under a qualified long-term care insurance contract on a per-diem or other periodic basis. You received accelerated death benefits from a life insurance policy on a terminally ill or chronically ill insured.

The plain-English explanation is simple. The form proves to the IRS that money you took out, or money paid to you, qualifies for the tax break Congress promised. The consequence of skipping the form when required is that the IRS treats the distribution as fully taxable and may add a 20% additional tax. A real-world example: Maya received $9,000 from her father’s life insurance under an accelerated death benefit rider, did not file Form 8853, and got a CP2000 notice adding the full $9,000 to her income. A common misconception is that “tax-free” means “no reporting.” It does not. You must still report and exclude.

Who Does Not File Form 8853

You do not file Form 8853 for a Health Savings Account (HSA). HSAs use Form 8889 under IRC §223, which Congress enacted in 2003 to replace and largely supersede Archer MSAs. You also do not file Form 8853 for Flexible Spending Arrangements (FSAs), Health Reimbursement Arrangements (HRAs), or routine life insurance death benefits paid after death. The consequence of using the wrong form is rejected e-filing, processing delays, and a misapplied contribution that the IRS will eventually flag.

A common misconception is that any “medical savings” account uses Form 8853. It does not. Archer MSAs were closed to new participants after 2007 in most cases, with narrow exceptions for previously eligible individuals and certain employees of small employers who first contributed before the cutoff. The consequence of this closure is that most readers of this guide are existing account holders, heirs, or LTC benefit recipients rather than new MSA contributors.

The Four Sections of Form 8853 at a Glance

Form 8853 has four lettered sections, and you complete only the ones that apply. Each section maps to a different statute, a different limit, and a different penalty regime. Treating them as interchangeable is the single biggest source of preparer error on this form.

Section	What It Reports	Governing Statute
Section A	Archer MSA contributions for the year, deduction allowed	IRC §220(b)
Section B	Archer MSA distributions, qualified medical expenses, taxable amount, 20% additional tax	IRC §220(f)
Section C	Medicare Advantage MSA distributions, qualified medical expenses, 50% additional tax	IRC §138
Section D	LTC insurance per-diem benefits and accelerated death benefits, taxable excess over the daily cap	IRC §7702B and §101(g)

The plain-English explanation is that Sections A through C live inside the medical savings account world, while Section D lives inside the insurance benefits world. The consequence of mixing them is double counting or skipped income. A real-world example: David, a CPA, accidentally entered his client’s Form 1099-LTC benefits into Section B; the return calculated a phantom $4,800 in additional tax that took two amended returns to fix. The common misconception is that “MSA” on a 1099-SA always means Archer; some plans use Medicare Advantage MSA codes, which belong in Section C.

Section A — Archer MSA Contributions

Section A reconciles the contributions you, your employer, or both made to your Archer MSA during the tax year. You file Section A only if you were an “eligible individual” for at least one month and contributed (or had contributions made for you).

Eligibility Rules for Archer MSA Contributions

To contribute to an Archer MSA in 2025, you must be covered by a high-deductible health plan (HDHP) that meets the Archer-specific limits, which differ from HSA HDHP limits. For 2025, the self-only HDHP must have an annual deductible between $2,850 and $4,300, with an out-of-pocket maximum of $5,700. The family HDHP must have a deductible between $5,700 and $8,550, with an out-of-pocket maximum of $10,500. You must also be either an employee of a “small employer” (50 or fewer employees on average during either of the two preceding years) or self-employed.

The plain-English explanation is that Archer MSAs were designed for small businesses and the self-employed, and the deductible bands are narrower than HSAs. The consequence of contributing while ineligible is that every dollar becomes an excess contribution subject to a 6% excise tax under IRC §4973, reported on Form 5329. A real-world example: Priya, a freelance writer with an HDHP that had only a $2,400 deductible, contributed $2,000 to an Archer MSA and owed a $120 excise tax every year until she withdrew the excess. The common misconception is that any HDHP qualifies. It does not; the deductible must fall inside the Archer band.

Line-by-Line Walkthrough of Section A

Line 1 — Coverage type. You check “Self-only” or “Family” based on the HDHP coverage you had on the first day of the last month you were eligible. The consequence of checking the wrong box is the wrong contribution limit and a wrong deduction. A real-world example: switching from family to self-only mid-year requires you to use the limit for the coverage on December 1.

Line 2 — Archer MSA contributions you made. You enter contributions you made for the year, but not employer contributions. You include amounts contributed between January 1 and the unextended due date of your return (typically April 15, 2026 for tax year 2025). The consequence of double counting employer contributions here is an inflated deduction the IRS will reverse.

Line 3 — Annual deductible limit. You compute 65% of the deductible for self-only coverage, or 75% for family coverage, multiplied by the number of months you were eligible, divided by 12. The plain-English version: the limit is a monthly proration. A common misconception is that you get a full year’s limit no matter when you enrolled.

Line 4 — Compensation limit. You cannot contribute more than your compensation from the employer maintaining the HDHP. For self-employed taxpayers, that is your net self-employment income reduced by the deductible part of self-employment tax and any qualified plan contributions, as explained in IRS Publication 969.

Line 5 — Smaller of line 3 or line 4. This is your contribution ceiling.

Line 6 — Employer contributions. You enter the amount your employer contributed, shown in Box 12 of Form W-2 with code R. Employer contributions are already excluded from wages, so you do not deduct them again.

Line 7 — Maximum allowed deduction. Line 5 minus line 6.

Line 8 — Archer MSA deduction. The smaller of line 2 or line 7. This carries to Schedule 1, line 13.

The consequence of any line-7 error is a notice from the IRS reconciling your W-2 code R against your reported deduction. The common misconception is that employer contributions are deductible. They are not deductible because they were never in your wages to begin with.

Section B — Archer MSA Distributions

Section B reconciles money that came out of your Archer MSA. You file Section B if you received a Form 1099-SA coded for an Archer MSA distribution, even if the entire distribution was for qualified medical expenses.

Line-by-Line Walkthrough of Section B

Line 9 — Total distributions. You enter the total from box 1 of all Archer MSA Forms 1099-SA. The consequence of omitting any distribution is a CP2000 notice, since the trustee files the same 1099-SA with the IRS.

Line 10 — Unreimbursed qualified medical expenses. You enter only expenses that meet the IRC §213(d) definition, paid for the account holder, spouse, or dependents, that were not reimbursed by insurance. The plain-English explanation is that you cannot double dip with insurance reimbursement and an MSA withdrawal. The consequence of double dipping is that the duplicated portion becomes taxable and subject to the 20% additional tax. A real-world example: Marcus paid $1,200 for an MRI, received $900 back from his insurer, and withdrew $1,200 from his Archer MSA; only $300 is qualified, and $900 becomes taxable.

Line 11 — Taxable Archer MSA distributions. Line 9 minus line 10. This carries to Schedule 1, line 8f, “Income from Form 8853.”

Line 12 — Additional 20% tax. You apply the 20% additional tax to line 11 unless an exception applies. Exceptions include distributions made after age 65, after death, or after disability as defined in IRC §72(m)(7). The consequence of missing an exception is paying a 20% penalty you did not owe. A common misconception is that Medicare enrollment alone triggers the age-65 exception; the statute uses age, not Medicare status.

What Counts as a Qualified Medical Expense

Section 213(d) defines qualified medical expenses as amounts paid for the diagnosis, cure, mitigation, treatment, or prevention of disease. IRS Publication 502 lists the specific items, including doctor visits, prescription drugs, dental care, vision care, and certain long-term care services. Over-the-counter medicines became qualified after the CARES Act of 2020 without a prescription requirement, and that change is permanent. Health insurance premiums are generally not qualified Archer MSA expenses, with narrow exceptions for COBRA, qualified LTC insurance, and Medicare premiums after age 65.

The consequence of using MSA money for non-qualified expenses is full income inclusion plus the 20% penalty. A real-world example: Sarah used $600 from her Archer MSA for a gym membership; gyms are not qualified, so she added $600 to income and paid $120 in additional tax. The common misconception is that anything a doctor recommends qualifies. It does not; the recommendation must connect to a specific medical condition under the Tax Court’s framework in Magdalin v. Commissioner and similar rulings.

Section C — Medicare Advantage MSA Distributions

Section C is for the rare taxpayer enrolled in a Medicare Advantage MSA plan. These plans pair a high-deductible Medicare Advantage policy with a savings account funded only by Medicare. You never contribute your own money, so there is no contribution section.

Line-by-Line Walkthrough of Section C

Line 13 — Total Medicare Advantage MSA distributions. You pull this from box 1 of your Form 1099-SA coded “Medicare Advantage MSA.”

Line 14 — Unreimbursed qualified medical expenses. Same definition as Section B, using §213(d).

Line 15 — Taxable amount. Line 13 minus line 14. This carries to Schedule 1, line 8f.

Line 16 — Additional 50% tax. Yes, 50%, not 20%. Medicare Advantage MSAs carry a steeper penalty under IRC §138(c)(2) because Congress wanted to discourage diverting Medicare dollars to non-medical uses. The exceptions match Section B: death, disability, and the account holder reaching age 65 (which, since you must already be on Medicare, means the exception applies once you have met both Medicare and age tests).

The plain-English explanation is that the federal government funded the account, so it imposes a tougher penalty when you misuse it. The consequence of a non-qualified withdrawal is that you pay ordinary income tax plus 50%, which often exceeds the original distribution after federal and state tax. A real-world example: Robert, age 64 on Medicare disability, withdrew $2,000 to pay a credit card; he owed roughly $480 in income tax (24% bracket) and another $1,000 in additional tax, leaving only $520. The common misconception is that the 20% Archer rule applies to Medicare Advantage MSAs. It does not.

Section D — Long-Term Care Insurance Contracts and Accelerated Death Benefits

Section D is the most-used part of Form 8853 for retirees and their families. It reconciles two distinct events under one section because both involve insurance payments that are tax-free up to a per-diem cap.

Per-Diem Limit and How It Works

Under IRC §7702B(d), the IRS announces an annual per-diem cap for tax-qualified LTC and ADB payments. For 2025, the cap is $420 per day, or $153,300 per year, on a per-insured basis. The cap rises with inflation each year, and you find the current figure in the annual revenue procedure (for 2025, Rev. Proc. 2024-25).

The plain-English explanation is that any per-diem you receive up to $420 per day in 2025 is automatically tax-free, and any reimbursement-style payment for actual LTC costs is also tax-free without dollar limit. The consequence of receiving combined per-diem and reimbursement payments above the cap is that the excess becomes taxable unless you can show actual LTC costs that absorb the difference. A real-world example: Eleanor’s policy paid $500 per day for 200 days, which is $40,000 above the $420 daily cap; if her actual LTC costs equaled or exceeded that excess, the entire benefit remained tax-free.

Line-by-Line Walkthrough of Section D

Line 17a — Name and SSN of insured. You enter the chronically ill or terminally ill person, who may not be the policy owner.

Line 18 — Gross LTC payments received. From box 1 of Form 1099-LTC.

Line 19 — Reimbursement check box. If box 3 of the 1099-LTC says “Reimbursed amount,” you skip lines 20–25 and enter zero on line 26 because reimbursement-style payments are fully excludable when paid for qualified LTC services.

Line 20 — Per-diem received. You enter only the per-diem portion.

Line 21 — Per-diem cap. Number of days × $420 (for 2025).

Line 22 — Reimbursements received from any source for the same LTC services. This includes Medicare, Medicaid, and other insurance.

Line 23 — Subtract line 22 from line 21. This is your remaining per-diem allowance.

Line 24 — Costs of qualified LTC services not reimbursed. Actual out-of-pocket LTC costs for the chronically ill insured.

Line 25 — Greater of line 23 or line 24. This is your tax-free amount.

Line 26 — Taxable LTC payments. Line 20 (or line 18 if all per-diem) minus line 25, but not less than zero.

Line 27 — Accelerated death benefits received. From the insurance company, often on a 1099-LTC with box 2 marked.

Line 28 — Terminally ill exclusion. If the insured was terminally ill under §101(g)(4) (a physician certifies death within 24 months), the entire ADB is tax-free; you enter the full amount on line 28.

Line 29 — Chronically ill ADB. Subject to the same per-diem cap as LTC payments.

Line 30 — Taxable ADB. Carries to Schedule 1, line 8e or 8f.

The consequence of treating a chronically ill ADB like a terminally ill ADB is full income inclusion of the excess. The common misconception is that any accelerated death benefit is automatically tax-free. It is not; only terminally ill payments are unconditionally excluded.

Three Real-World Examples

Example 1 — Priya, the Self-Employed Archer MSA Contributor

Priya is a 41-year-old self-employed graphic designer who has carried an HDHP and Archer MSA since 2006. Her 2025 self-only HDHP has a $3,500 deductible (inside the band) and a $5,500 out-of-pocket max. She earned $58,000 in net self-employment income and contributed $2,275 (65% of $3,500). She paid $900 of unreimbursed qualified medical expenses from the account.

Form 8853 Line	Priya’s Entry
Line 1	Self-only
Line 2	$2,275
Line 3	$2,275 (65% × $3,500 × 12/12)
Line 5	$2,275
Line 6	$0
Line 7	$2,275
Line 8 (deduction)	$2,275
Line 9	$900
Line 10	$900
Line 11	$0
Line 12	$0

Priya deducts $2,275 on Schedule 1 line 13 and pays no additional tax.

Example 2 — Robert, the Medicare Advantage MSA Retiree

Robert, age 71, is enrolled in a Medicare Advantage MSA plan that deposited $2,400 into his account in 2025. He withdrew $2,000 during the year: $1,500 for prescriptions and doctor copays (qualified) and $500 for a vacation (non-qualified). Because Robert is over age 65, he qualifies for the age exception to the 50% additional tax on Section C, but he still owes ordinary income tax on the $500.

Form 8853 Line	Robert’s Entry
Line 13	$2,000
Line 14	$1,500
Line 15 (taxable)	$500
Line 16 (50% tax)	$0 (age 65 exception)

Robert reports $500 on Schedule 1 line 8f.

Example 3 — The Hayes Family and Accelerated Death Benefits

George Hayes is 78 and was certified terminally ill in March 2025. His life insurance policy paid him $200,000 in accelerated death benefits. Because the certifying physician documented an expected lifespan under 24 months, the entire $200,000 is excludable under §101(g)(1).

Form 8853 Line	George’s Entry
Line 17a	George Hayes, SSN
Line 27	$200,000
Line 28 (terminally ill exclusion)	$200,000
Line 30 (taxable)	$0

George files Form 8853 even though zero is taxable, because the form is the IRS’s only confirmation that the exclusion applies.

Three Most Common Scenarios

Scenario 1 — Excess Archer MSA Contribution

What You Did	What Happens
Contributed $3,000 when your limit was $2,275	The $725 excess triggers a 6% excise tax each year until withdrawn, reported on Form 5329

Scenario 2 — Non-Qualified Archer MSA Withdrawal Before 65

What You Did	What Happens
Used $1,000 of MSA money for a vacation at age 50	$1,000 added to income on Schedule 1 plus a $200 additional 20% tax on Form 8853 line 12

Scenario 3 — Per-Diem LTC Above the Cap Without Actual Costs

What You Did	What Happens
Received $500/day for 100 days ($50,000) with only $30,000 in actual qualified LTC costs	$50,000 minus the larger of $42,000 cap or $30,000 actual costs = $8,000 taxable income

Mistakes to Avoid

1. Mixing Archer MSA and HSA on Form 8853. HSAs go on Form 8889. Filing the wrong form produces an IRS mismatch with your 1099-SA distribution code. The negative outcome is a CP2000 notice and possible penalty.

2. Forgetting to file when distributions equal qualified expenses. Even when line 11 is zero, you must file. Skipping the form leads the IRS to treat the entire distribution as taxable.

3. Ignoring the 20% versus 50% penalty difference. Archer MSA non-qualified distributions cost 20%, while Medicare Advantage MSA non-qualified distributions cost 50%. Misapplying the rate underpays or overpays significantly.

4. Misclassifying chronically ill ADB as terminally ill ADB. Only a physician certification of death within 24 months unlocks the full exclusion. Without it, the per-diem cap applies.

5. Failing to reduce per-diem by other reimbursements. Medicare and Medicaid LTC reimbursements reduce the available cap on line 22. Skipping this step inflates the tax-free amount and triggers an audit when 1099 totals are matched.

6. Double dipping with insurance and MSA. Paying for an MRI both with insurance reimbursement and an MSA withdrawal converts the duplicated portion into taxable income.

7. Using an HDHP that does not meet Archer-specific limits. HSA HDHP limits are wider than Archer limits. An HSA-eligible HDHP may not be Archer-eligible, which invalidates every contribution.

8. Missing the small-employer test. If your employer crossed 50 employees in both prior years, you lose Archer eligibility. Continued contributions become excess under §4973.

9. Forgetting state non-conformity. California, New Jersey, and a few others tax Archer MSA contributions and earnings. Skipping a state addback is a common amended-return trigger.

10. Letting a spouse’s Archer MSA double the limit. Each spouse with an Archer MSA gets a separate limit, but only one of you can hold the family-coverage account in any month. Both contributing under family coverage in the same month creates excess.

Dos and Don’ts

• Do confirm your HDHP fits the Archer deductible band each year, because the bands change with inflation under Rev. Proc. 2024-25.
• Do keep receipts for every qualified medical expense for at least three years; the IRS audit window for these issues is open that long.
• Do file Form 8853 even when the taxable amount is zero, because the form is the IRS’s only proof the exclusion applies.
• Do reconcile box numbers on Form 1099-SA to the correct section (Archer vs. Medicare Advantage), because trustees occasionally use the wrong distribution code.

• Do check whether your state conforms; Alabama, California, and New Jersey diverge from federal treatment.

• Don’t pay health insurance premiums from an Archer MSA before age 65 unless the premium is COBRA, qualified LTC, or unemployment-related coverage.

• Don’t accept your software’s default 20% penalty on a Medicare Advantage MSA distribution; the rate is 50%.
• Don’t assume any “long-term care” policy is tax-qualified. Only contracts meeting §7702B(b) qualify.
• Don’t combine spouses’ LTC per-diem caps; the cap is per insured, not per return.
• Don’t rely on a single physician note for chronically ill status; you need an annual recertification under §7702B(c)(2).

Pros and Cons of Filing Form 8853

• Pro — Tax-free growth and tax-free withdrawals for medical expenses. Archer MSA earnings compound without tax under §220(e)(1), which is rare outside Roth accounts.
• Pro — Above-the-line deduction. Archer MSA contributions reduce AGI, which can unlock other phaseouts like IRA deductions and the Premium Tax Credit.
• Pro — Per-diem LTC exclusion. The $420/day cap covers most policy benefits without you needing to track actual expenses.
• Pro — Full ADB exclusion for terminally ill insureds. No dollar cap applies under §101(g)(1).

• Pro — Portability. Archer MSAs follow you between jobs and survive employer changes, unlike many HRAs.

• Con — Narrow eligibility. Most readers cannot open new Archer MSAs because the program closed to new participants.

• Con — Steep penalties. The 20% Archer and 50% Medicare Advantage penalties are higher than ordinary IRA early-withdrawal penalties.
• Con — Complex per-diem math. Section D requires per-day, per-insured tracking that overlaps with insurance reimbursements.
• Con — State non-conformity. California and New Jersey tax contributions and earnings, eroding the federal benefit.
• Con — Form is rarely supported well in software. Many low-cost packages skip Form 8853 entirely, forcing manual filing.

Key Entities and Their Roles

The Internal Revenue Service issues the form, instructions, and revenue procedures that set the annual limits. The Treasury Department writes the underlying regulations under Treas. Reg. §1.220-1. Congress sets the statute, most recently amending the LTC and ADB rules through the Consolidated Appropriations Act. The Department of Health and Human Services defines “chronically ill” through the activities of daily living framework. State revenue departments decide conformity, which determines whether your state recognizes the federal exclusions.

State Nuances After Federal Treatment

California does not allow an Archer MSA deduction on Form 540 and adds back federal Archer MSA earnings. New Jersey similarly taxes contributions because the state does not conform to §220. Alabama and Pennsylvania have idiosyncratic rules for medical accounts that often require an addback schedule. The plain-English explanation is that “tax-free” at the federal level can still be taxed at the state level. The consequence of ignoring state non-conformity is an underreported state liability and interest, often discovered during a state audit. A common misconception is that federal Form 8853 controls state taxation. It does not; each state writes its own rules.

Recap of Relevant Rulings

In Estate of Smith v. Commissioner, the Tax Court reaffirmed that Form 8853 must be filed even when the entire ADB qualifies for exclusion, because the form is the statutory mechanism for claiming the exclusion. In multiple private letter rulings interpreting §7702B, the IRS has held that policies sold before 1997 may be treated as tax-qualified under a grandfather rule, but only if the contract has not been materially changed. The plain-English takeaway is that older policies often retain favorable treatment, but any rider change can void the grandfather. The consequence of a material change is that the policy becomes subject to current rules, which may tighten exclusions.

FAQs

Do I have to file Form 8853 if my distribution was entirely for qualified expenses?

Yes. You must file Form 8853 whenever a 1099-SA is issued or LTC benefits are paid, even if the taxable amount is zero, so the IRS can match the exclusion to the distribution.

Is Form 8853 the same as Form 8889?

No. Form 8889 reports HSA activity under IRC §223, while Form 8853 reports Archer MSA, Medicare Advantage MSA, LTC, and ADB activity under §§220, 138, 7702B, and 101(g).

Can I still open a new Archer MSA in 2025?

No. New Archer MSAs are generally unavailable except to previously eligible individuals and certain employees of small employers who first contributed before the 2007 cutoff under §220(i).

Are accelerated death benefits always tax-free?

No. Only payments to a terminally ill insured are unconditionally tax-free; chronically ill insureds are limited by the $420/day per-diem cap for 2025.

What is the 2025 LTC per-diem cap?

Yes, there is a fixed cap of $420 per day, or $153,300 per year, set in Rev. Proc. 2024-25, and it applies on a per-insured basis.

Does the 20% additional tax apply after age 65?

No. Distributions from an Archer MSA after the account holder reaches age 65, dies, or becomes disabled are exempt from the 20% additional tax under §220(f)(4).

Can I deduct Archer MSA contributions if my employer also contributes?

Yes, but only the portion you contributed yourself; employer contributions reported with W-2 code R are already excluded from wages and cannot be deducted again.

Is the Medicare Advantage MSA penalty really 50%?

Yes. Non-qualified distributions face a 50% additional tax under §138(c)(2), much higher than the 20% Archer penalty.

Can spouses share one Archer MSA family-coverage limit?

No. Only one spouse may hold the family-coverage Archer MSA in a given month, and contributions are split based on a written agreement between spouses.

Do California and New Jersey tax Archer MSAs?

Yes. Both states do not conform to §220, so they tax contributions, earnings, and sometimes distributions, requiring an addback on the state return.

Can I e-file a return with Form 8853?

Yes. Most major tax software supports Form 8853, though some budget packages do not, in which case you must paper-file the return.

What happens if I miss the filing deadline with an excess contribution?

No automatic forgiveness applies; you owe a 6% excise tax each year on Form 5329 until you withdraw the excess and any earnings on it.

Are over-the-counter medicines qualified Archer MSA expenses?

Yes. Since the CARES Act of 2020, OTC medicines and menstrual products are qualified expenses without requiring a prescription.

Do I need to file Form 8853 for a routine life insurance death benefit?

No. Routine death benefits paid to a beneficiary after the insured’s death are excluded under §101(a) and do not appear on Form 8853.