EBRI Issue Brief

Trends in Health Savings Account Balances, Contributions, Distributions, and Investments, 2011–2022

Mar 21, 2024 23  pages


Plan sponsors that wish to introduce or continue offering health savings account (HSA)-eligible health plans as part of their workplace benefit program can benefit from a long-term view of HSA accountholder behaviors. As such, the Employee Benefit Research Institute (EBRI) has undertaken a series of longitudinal studies from its HSA Database, examining trends in account balances, individual and employer contributions, distributions, invested assets, and account-owner demographics from 2011‒2022. Such analysis can help not only plan sponsors but providers and policymakers better understand strategies that can help improve employee financial wellness.

The Employee Benefit Research Institute (EBRI) developed the EBRI HSA Database to analyze the state of and individual behavior in health savings accounts (HSAs). The HSA Database contains 14 million accounts with total assets of $42.5 billion as of Dec. 31, 2022.

Key findings:

HSAs offer a triple tax advantage to accountholders, enabling them to stretch money they have saved for health care expenses further than they otherwise could. The tax benefits of HSAs are maximized when accountholders contribute the statutory maximum and minimize withdrawals for current medical expenditures — if they are able — and invest their HSA balances in assets other than cash. However, the majority of accountholders appear to use their HSAs to pay for current expenses and do not take complete advantage of the tax benefits HSAs offer. Average contributions are well below the statutory maximum, most accountholders take a distribution from their HSA, and relatively few accountholders invest. This is not to say, however, that the whole picture is bleak; despite patients spending more on health care in 2022 than in previous years, average balances in HSAs increased, rising from $4,318 in 2021 to $4,607. And, encouragingly, the share of accountholders who invest their HSAs has crept steadily upward since EBRI began analyzing its HSA Database.

From this study, we observe the following about HSA utilization:

  • Relatively low balances: Since the establishment of EBRI’s HSA Database, average account balances have generally trended upward, and 2022 was no exception. End-of-year balances increased in 2022 to $4,607, but overall, average balances are still modest. This may be a result of the fact that many of the HSAs in EBRI’s HSA Database are relatively new; roughly one-third were opened since 2021.
  • Contributions below the maximum: Relative to 2022, average HSA contributions increased. Average individual contributions rose to $1,962, while the average employer contribution decreased slightly to $762. However, the growth in individual contributions outweighed the decrease in employer contributions, resulting in higher total contributions in 2022 than in 2021. However, notably, the average combined HSA contribution was $926 less than the statutory maximum contribution for individuals and $4,576 less than the statutory maximum contribution for accountholders with family coverage.
  • High incidence of withdrawals: Overall, over one-half of accountholders withdrew funds. The average distribution rose to $1,868, continuing to rise from the COVID-era lows observed in 2020.
  • Low use of investments: Few accountholders took advantage of the ability to invest HSA funds, as only 13 percent of accountholders invested in assets other than cash. However, the share of accountholders who invested their HSAs has increased for six years in a row, which is an encouraging sign that accountholders are increasingly leveraging the powerful tax advantages HSAs offer.

In addition to tax benefits, HSAs also allow accountholders to roll over their balances from year to year to accumulate more savings for future medical expenditures, as well as medical expenditures in retirement. Medical expenses in retirement can be substantial, with married couples potentially needing to save as much as $413,000 (Spiegel and Fronstin 2024). On average, accountholders appear to be using HSAs as specialized checking accounts rather than investment accounts, though this behavior appears to change the longer an HSA owner holds an account. Over the past decade of conducting longitudinal analysis of its HSA Database, EBRI finds evidence that the longer an accountholder has had their HSA, the higher the likelihood that the accountholder invests their HSA in assets other than cash, in addition to contributing more on average and enjoying higher account balances.