Trends in Health Savings Account Balances, Contributions, Distributions, and Investments, 2011–2023

Summary

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 2011‒2023. Such analysis can help plan sponsors, providers, and policymakers better understand strategies that can help improve employee financial wellness.

Key findings:

HSAs offer a triple tax advantage to accountholders, enabling them to stretch money they save 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. We do find that, as time goes on, accountholders tend to take fuller advantage of the benefits HSAs offer. And, despite out-of-pocket spending on health care rising by 7.5 percent in 2023, average balances in HSAs increased, rising from $4,607 in 2022 to $4,747 in 2023. Further, 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 2023 was no exception. End-of-year balances increased in 2023 to $4,747, but overall, average balances are still modest compared with out-of-pocket maximums for HSA-eligible health plans ($8,300 for individual coverage in 2025, $16,600 for family coverage). This may be a result of the fact that many of the HSAs in EBRI’s HSA Database are relatively new; almost 40 percent were opened since 2021.
• Contributions below the maximum: Relative to 2022, average HSA contributions increased. Among accountholders who made a contribution, the average employee contribution rose to $2,075, while the average employer contribution decreased slightly to $1,015. However, after adjusting for inflation, both employer and employee contributions were higher in the 2010s. Also, notably, the average combined HSA contribution was $760 less than the statutory maximum contribution for individuals and $4,660 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 $1,801. While larger than in years past, average distributions were higher in the mid-2010s after adjusting for inflation.
• Low use of investments: Few accountholders took advantage of the ability to invest HSA funds, as only 15 percent of accountholders invested in assets other than cash. However, the share of accountholders who invested their HSAs has increased for seven years in a row, 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.