The amount in box 5 is informational only. It is not something you can deduct on Schedule A as itemized deduction for medical expenses. Can you provide more information about the type of distribution that is being reported on your 1099-R? According to the IRS, entries in Box 5 of Form 1099-R can be used for any of the following:
- (a) designated Roth account contributions or contributions actually made on behalf of the employee over the years under the plan that were required to be included in the income of the employee when contributed (after-tax contributions),
- (b) contributions made by the employer but considered to have been contributed by the employee under section 72(f),
- (c) the accumulated cost of premiums paid for life insurance protection taxable to the employee in previous years and in the current year under Regulations section 1.72-16 (cost of current life insurance protection) (only if the life insurance contract itself is distributed), and
- (d) premiums paid on commercial annuities.
I suggest you contact your plan administrator and ask them to explain why Box 1 and Box 2a are the same when there is an amount reported in Box 5.
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