EBRI Issue Brief

Health Savings Account Balances, Contributions, Distributions, and Other Vital Statistics, 2018: Statistics From the EBRI HSA Database

Dec 5, 2019 27  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 insight into HSA accountholder behaviors. With this in mind, the Employee Benefit Research Institute (EBRI) has undertaken a series of annual reports drawing on cross-sectional data from the EBRI HSA Database. In the sixth annual report of this kind, EBRI examines account balances, individual and employer contributions, distributions, invested assets, and account-owner demographics as of year-end 2018. Such analysis can help not only plan sponsors but providers and policymakers better understand strategies that can help improve employee financial wellness.

Key findings this year are that:

HSAs are a significant and growing part of employment-based health benefit programs.

  • Enrollment in high-deductible, HSA-eligible health plans was estimated to be between 23 and 36.8 million policyholders and their dependents and covered nearly 3 in 10 employees in 2018. The HSA market did not exist until 2004.
  • Similarly, there were an estimated 25 million HSAs as of the end of 2018. Most HSAs in the EBRI HSA Database are relatively new; 71 percent have been opened since 2015.

HSA balances increased in 2018.

  • Two-thirds of accountholders ended 2018 with positive net contributions, meaning annual contributions were higher than annual distributions.
  • 93 percent of HSAs with individual or employer contributions in 2018 ended the year with funds to roll over for future expenses.
  • As of the end of 2018, the average HSA balance among accountholders with individual or employer contributions in 2018 was $2,803, up from $2,071 at the beginning of the year. Only 8 percent of accounts with contributions ended 2018 with a zero account balance.

Contributions to HSAs are rarely maximized.

  • One-half of HSA owners contributed to their account in 2018, and 37 percent of HSAs did not receive any contributions (individual or employer) in 2018.
  • Among accounts with contributions, individual contributions in 2018 averaged $2,017, and employer contributions averaged $901.
  • Only 14 percent of accountholders contributed the fully allowable annual amount.
  • Three-fourths (76 percent) of HSAs with a 2018 contribution also had a distribution during 2018. Of the HSAs with distributions, the average amount distributed was $1,865, less than the average contribution, resulting in balance increases.

Investing alone does not maximize longer-term savings.

  • Only 5 percent of HSAs had invested assets (beyond cash).
  • Investors (beyond cash) had much higher account balances than non-investors.
  • While it might be expected that individuals who invested their account balance were using the account solely as a long-term savings vehicle, the opposite appears to have been true. Both investors and non-investors used the HSA to self-fund medical expenses.
  • Investors were more likely than non-investors to take a distribution (63 percent and 59 percent, respectively). In fact, when distributions were taken, investors took larger distributions ($2,570) than non-investors ($1,828) during 2018. However, the larger distributions may have been because they had larger account balances.