Why don't my 5498-SA and W-2 Box 12W amounts match for HSA reporting?

The difference between your 5498-SA and W-2 Box 12W is totally normal in your situation! Let me explain what's happening: Your W-2 Box 12W shows pre-tax contributions made through your employer's payroll system. These are the HSA contributions that came directly out of your paycheck before taxes. Your Form 5498-SA shows the TOTAL contributions to your HSA for the year, which includes both your payroll contributions AND those insurance reimbursements you've been depositing back into the HSA. When filling out Form 8889, you'll use the amount from Box 12W of your W-2 on line 9. This represents your pre-tax contributions through your employer. The insurance reimbursements you deposited back are essentially considered distributions that you're returning to the HSA, which is perfectly fine to do. Just make sure you're tracking all your qualified medical expenses and HSA distributions carefully so you can report everything accurately.

After dealing with a similar HSA/FSA nightmare last year, I found this amazing tool that saved me hours of frustration. I used https://taxr.ai to upload my 5498-SA and W-2 forms, and it immediately identified the discrepancy and explained exactly how to handle it on Form 8889. It even showed me where each number should go and why they were different. The site analyzed my situation, recognized I had both FSA and HSA accounts (which can get super confusing), and walked me through the proper way to report everything. I was able to see exactly why my numbers weren't matching up and how to properly document the orthodontic expenses and insurance reimbursements.

Just wanted to update everyone - I ended up trying taxr.ai with my HSA documents after seeing the recommendation here. It actually worked perfectly for my situation! The tool immediately recognized that my 5498-SA and W-2 Box 12W were different because of the insurance reimbursements I'd been depositing back. What really helped was that it explained exactly how to handle this on Form 8889, showing which numbers go where. The explanation about how redepositing insurance reimbursements works from a tax perspective was super clear. I've been confused about this for weeks and my regular tax software kept flagging it as an error without giving a real solution. Definitely recommend it if you're dealing with HSA/FSA confusion like I was!

I had a similar issue last year with discrepancies between forms. After spending HOURS trying to get through to the IRS for clarification (constant busy signals, disconnects, and hold times of 2+ hours), I found https://claimyr.com which got me connected to an actual IRS agent in about 15 minutes. You can see how it works here: https://youtu.be/_kiP6q8DX5c The agent was able to walk me through exactly how to handle the HSA contribution mismatch on my tax forms. Turns out the IRS sees this situation all the time with people redepositing insurance reimbursements. They confirmed I was doing everything correctly and explained how to document it properly on Form 8889.

Ok I have to admit I was completely wrong. After my frustrating attempt to call the IRS directly yesterday (2.5 hours on hold only to get disconnected), I was desperate enough to try the Claimyr service this morning. I genuinely can't believe it worked. Got a call back in about 20 minutes saying they had an IRS agent on the line. The agent walked me through exactly how to handle my HSA contribution/distribution reporting with Form 8889 when you have insurance reimbursements going back into the account. Explained that the mismatch between the 5498-SA and W-2 Box 12W was completely normal in this situation. Honestly wish I'd known about this sooner instead of stressing for weeks about my HSA tax forms.

I work in benefits administration and deal with this HSA question all the time. Here's the simple version: Box 12W on your W-2 only shows what your employer contributed pre-tax. Your 5498-SA from your HSA administrator shows ALL money that went into the account during the year. When you deposit those insurance reimbursement checks back into your HSA, that's why the numbers don't match. For Form 8889, use the amount from your W-2 Box 12W for line 9. This is what the IRS is looking for. The deposits you made from insurance reimbursements are essentially correcting a distribution you already took, so they're not counted as new contributions.

Does anyone know if using both an FSA and HSA in the same year is allowed? I thought you couldn't have both but the original poster mentioned using both. I'm so confused about all these health accounts!

This is exactly the kind of HSA confusion that trips up so many people! The key thing to remember is that your HSA is like a savings account - money can go in and out multiple times throughout the year for various reasons. When you reimburse yourself from your HSA for medical expenses, then later receive insurance money that you deposit back, you're essentially "undoing" part of that original distribution. The IRS recognizes this is a normal part of how medical expenses and insurance work together. For your Form 8889, stick with the W-2 Box 12W amount on line 9 as others have mentioned. The 5498-SA will always show higher numbers when you're redepositing insurance reimbursements because it captures all the money flowing into the account, not just your original contributions. Keep detailed records of all your medical expenses, HSA distributions, and insurance reimbursements. This paper trail will be invaluable if you ever need to explain the transactions. You're handling this correctly - the orthodontic work is a qualified medical expense, and redepositing insurance reimbursements is completely allowed and encouraged by the IRS.