Summary
Key findings from 2024 year-end data include:
- HSA balances continued to increase over the course of the year, despite higher spending on health care. Out-of-pocket patient spending on health care increased in 2024, rising 5.9 percent over 2023. Despite increased spending on health care, the average HSA ended the year with a higher balance than it started the year. Average balances increased at an even faster rate in 2024, conditional on those accounts receiving either an employee or employer contribution over the course of the year.
- Consistent with prior years, accounts that received an employer contribution saw higher total contributions and were more likely to be invested. Employers seeking to help their workers engage with their HSAs may find employer contributions to be a useful tool, as accountholders who received an employer contribution on their behalf had higher average total contributions and were more likely to invest. Our analysis indicates, however, that these accountholders were also more likely to take more frequent and larger distributions.
- Most accountholders took a distribution in 2024. More than half — 56 percent — of the HSAs in EBRI’s database saw a distribution in 2024, and the average distribution was $1,870.
- Most actively contributing accountholders added more to their HSAs than they withdrew in 2024. Net contributions were positive across all age groups and generally increased with age, suggesting that many accountholders continued to build HSA balances despite using their accounts to pay for current health care expenses.
- Despite the tax advantages, fewer than one in five accountholders invested. One of the largest advantages HSAs offer is the ability to invest assets within the account. However, our analysis reveals that only 18 percent of accountholders invested their HSAs in assets other than cash.
- Age and tenure play a major role in HSA utilization. Consistent with previous findings, accountholder age — as well as accountholder tenure — is closely related to average balances, contributions, and distributions, as well as the propensity to invest. On average, older accountholders contributed more to their HSAs, had higher balances, more frequently took distributions, and had a higher likelihood of investing at least some portion of their HSA in assets other than cash.