>I received a 5498-SA the other day, which reminded me that I still have
>an HSA sitting around. I've never actually used it, so I'm a little
>vague on how they work.
>Do I need to keep track of medical expenses that are paid by the HSA?
Yes, you have to keep track.
>Put them on Schedule A and then declare the money coming out of it
>as income? Or does the fact that the two offset each other mean that
>neither will show up on my 1040 (and schedules)?
Medical expenses that you pay from your HSA cannot be
deducted on Schedule A.
The amount you took out of the HSA, and the amount you used
for qualified medical expenses, go in Part II of Form 8889.
If those two amounts are equal, i.e. all the money from the
HSA was used for qualified medical expenses, then it doesn't
appear on Form 1040 or anywhere else besides Form 8889. If
any money from the HSA was not used for qualified medical
expenses, that amount will be reported as income on Schedule
1. Unless you qualify for an exception, the amount that was
not used for qualified medical expenses will also be subject
to an additional 20% penalty.