HSA Balances Went Up in 2024, but Participant Spend Ticked Down

Participant contributions to and asset investments in health savings accounts increased for the third consecutive year, boosting average account balances, according to the Plan Sponsor Council of America’s 2025 HSA Survey.

Meanwhile, plan sponsors cited employee education as their most common HSA concern—with most employers only providing education once per year: at open enrollment. A recent Lively Inc. study found HSA holders are withdrawing more than they are saving, citing rising health care costs.

Nonetheless, HSA expansion is on the rise. At year-end 2024, HSA assets reached $146.64 billion, an increase of almost 16% from the year-end 2023 total of $123 billion, according to the 2024 Devenir & HSA Council Demographic Survey. PSCA found that in 2024, more than half (57%) of employees chose an HSA-qualifying health option, known as a high-deductible health plan, when offered a choice.

The One Big Beautiful Budget Act, signed into law by President Donald Trump on July 4, is expected to expand HSA usability further. The law allows individuals enrolled in HDHPs to participate in direct primary care benefits and to pay direct primary care fees from their HSAs if their monthly fees are $150 or less ($300 or less for family coverage), effective January 1, 2026.

“HSAs can be a powerful tool to help save for and pay for current and future healthcare expenses,” said Hattie Greenan, director of research and communications for PSCA, in a statement. “It’s encouraging to see more employers offer investments and employees taking advantage of them to grow their accounts.”

Investments and Balances Up

Three-quarters of employees with an HSA made contributions to their accounts last year, with an average contribution of $2,802—up from $2,609 in 2023 and $2,323 in 2022, PSCA found. The average account balance hit $6,489, an increase from $6,165 and $6,130 respectively, in the prior years.

In addition, two-thirds of employers offered HSAs that made investment options available to their HSA participants in 2024, a 12% increase from two years prior. Among participants in 2024, 20% then invested their HSA savings, up from 18% in 2023.

Additionally, three-quarters of employers made contributions to employees’ HSAs, with more than half (54.9%) providing a set amount per coverage level and 27.4% providing a specified amount per employee, the study found.

Employers’ automatic enrollment practices promoted employee engagement with HSAs, as well. Forty-three percent of organizations surveyed automatically enrolled employees in the HSA if they enrolled in an HSA-qualifying health insurance option, a slight tick up from 2023.

What to Watch

Despite growth in the use of HSAs and their availability, account withdrawals increased by 13% in 2024 from 2023, according to benefits provider Lively. The company found its customers spent an average of 80% of their health care account assets in 2024, mirroring a June study from the Employee Benefit Research Institute that found one-third of HSA holders withdrew more than they contributed in 2023.

Less than 30% of respondents to PSCA’s survey indicated that, when communicating with employees, they position the HSA as part of a retirement savings strategy—a proportion consistent with that seen over the past several years. Slightly less than 30% allowed participants to view or load their HSA balance into their retirement account portals.

Simultaneously, participant education remained a chief concern among employers. When asked to select multiple education goals, 73% of employers identified educating their employees on the tax benefits of HSAs as a primary or secondary goal, followed by 42% who named understanding the contribution limits.

“As more people seek ways to manage rising healthcare costs, employers have an opportunity to increase engagement with HSAs to support both short-term healthcare expenses and long-term financial health,” said Kevin Robertson, HSA Bank’s chief growth officer, in a statement. “By communicating with employees in multiple ways, contributing to accounts, providing automatic enrollment and rewarding healthy behaviors, employers can help close knowledge gaps and support informed health and wealth decisions.”

The survey, sponsored by HSA Bank, was fielded in the summer of 2025. PSCA sought responses from nearly 600 companies that offered a high-deductible health plan and an HSA program to employees in 2024.