With assets skyrocketing to $128.5 billion and millions of new accounts opening each year, the Health Savings Account (HSA) industry has exploded from a niche benefit into a financial juggernaut reshaping how Americans pay for healthcare.
Key Takeaways
- In 2023, the total assets held in Health Savings Accounts (HSAs) in the US reached $128.5 billion, reflecting a 12% year-over-year growth.
- The HSA market size was valued at $45.2 billion in 2022 and is projected to grow to $72.8 billion by 2030 at a CAGR of 6.2%.
- Global HSA and similar accounts managed $150 billion in assets under management as of mid-2023.
- As of 2023, there were 36.8 million HSA accounts in the US.
- HSA enrollment grew by 11% year-over-year to 36.8 million accounts in 2023.
- 28% of US workers with HDHPs had an HSA in 2023.
- As of 2023, average HSA balance was $3,833 across all accounts.
- Total HSA assets grew 13% to $128.5 billion in 2023.
- Invested HSA assets reached $38.4 billion, up 24% from 2022.
- Total employee contributions to HSAs reached $28.4 billion in 2023.
- Average annual employee contribution per HSA was $1,200 in 2023.
- Employer contributions totaled $12.6 billion across all HSAs in 2023.
- In 2023, 65% of HSA funds were spent on qualified medical expenses.
- Average annual withdrawal per HSA was $1,450 in 2023.
- Non-medical withdrawals (taxed + penalty) were 5% of total distributions in 2023.
The HSA industry is rapidly growing in both total assets and user enrollment.
Asset Accumulation
- As of 2023, average HSA balance was $3,833 across all accounts.
- Total HSA assets grew 13% to $128.5 billion in 2023.
- Invested HSA assets reached $38.4 billion, up 24% from 2022.
- Median HSA balance for families was $6,920 in 2023.
- Cash-held HSA assets totaled $90.1 billion in 2023.
- Average invested balance per account was $12,450 in 2023.
- HSA assets in mutual funds amounted to $22.7 billion in 2023.
- Year-end 2023 average balance per account rose 8% to $3,833.
- Total HSA assets per capita among enrollees was $3,490 in 2023.
- ETFs held in HSAs totaled $9.8 billion in assets in 2023.
- Average balance for accounts over 10 years old was $28,500 in 2023.
- HSA assets in fixed-income securities reached $5.2 billion in 2023.
- Million-dollar HSA balances numbered 1,200 in 2023.
- Average annual asset growth rate per HSA was 9.2% from 2018-2023.
- HSA assets allocated to stocks were 35% of invested portfolios in 2023.
- Total rollover contributions to HSAs added $4.1 billion in assets in 2023.
- HSA assets in target-date funds hit $3.6 billion in 2023.
- Female-held HSA average balance was $3,210 vs. $4,560 for males in 2023.
- Regional average: Midwest HSA balances averaged $4,100 in 2023.
- HSA assets growth outpaced inflation by 4.5% in 2023.
- Accounts with balances over $50,000 totaled 150,000 in 2023.
- Average employer seed money contributed $650 per new HSA in 2023.
- HSA assets in alternative investments reached $1.2 billion in 2023.
- Year-over-year asset increase for millennials' HSAs was 15% in 2023.
- Total HSA assets held by top 10 custodians: $105 billion in 2023.
- Average balance growth for family HSAs was 10.2% in 2023.
- HSA assets per enrolled employee averaged $5,200 in large firms in 2023.
Asset Accumulation Interpretation
The numbers paint a tale of two savers: while the prudent few are steadily building formidable, investment-powered health nest eggs, the cautious majority are still parking their contributions in cash, leaving billions in potential growth on the table.
Contribution Trends
- Total employee contributions to HSAs reached $28.4 billion in 2023.
- Average annual employee contribution per HSA was $1,200 in 2023.
- Employer contributions totaled $12.6 billion across all HSAs in 2023.
- Average employer contribution per participant was $650 in 2023.
- Total contributions (employee + employer) hit $44.3 billion in 2023.
- 68% of HSA holders made at least one contribution in 2023.
- Maximum IRA rollover to HSA used by 45,000 accounts, contributing $1.8 billion in 2023.
- Average monthly contribution rate was $150 per active HSA in 2023.
- Employer contribution as % of salary averaged 0.8% in 2023.
- Catch-up contributions (age 55+) totaled $950 million in 2023.
- 42% of employers offered matching contributions up to $1,000 in 2023.
- Average contribution for family coverage HSAs was $2,100 in 2023.
- Payroll deduction contributions accounted for 88% of total in 2023.
- Millennials contributed an average of $950 annually to HSAs in 2023.
- Total catch-up eligible contributions grew 12% to $950 million in 2023.
- Small business average employer contribution was $450 per employee in 2023.
- Contribution frequency: 55% monthly, 30% quarterly in 2023.
- Female contributors averaged $1,050 vs. $1,380 for males in 2023.
- Public employers contributed $1.2 billion total to HSAs in 2023.
- Average first-year contribution was $850 per new HSA in 2023.
- HSA contribution tax savings for employees totaled $8.5 billion in 2023.
- 75% of large employers increased contributions by 5% in 2023.
- Gig workers' average annual HSA contribution was $620 in 2023.
- Total employer non-elective contributions rose 10% to $12.6 billion in 2023.
- Contribution utilization rate among enrollees was 72% in 2023.
- Average contribution per millennial family HSA was $1,750 in 2023.
- HSA debit card contribution loads averaged $120 monthly in 2023.
Contribution Trends Interpretation
Americans are dutifully stuffing their health savings accounts with billions, proving that when faced with the delightful choice between a new TV and future medical bills, a surprising number are grimly choosing the latter.
Enrollment Statistics
- As of 2023, there were 36.8 million HSA accounts in the US.
- HSA enrollment grew by 11% year-over-year to 36.8 million accounts in 2023.
- 28% of US workers with HDHPs had an HSA in 2023.
- New HSA openings totaled 4.5 million in 2023.
- Employer-sponsored HSA enrollment reached 24 million in 2023.
- Individual HSA accounts numbered 12.8 million in 2023.
- HSA penetration among eligible families hit 42% in 2023.
- Enrollment in HSAs via payroll deduction was 85% of total in 2023.
- States with highest HSA enrollment: Texas with 2.9 million accounts in 2023.
- Millennial enrollment in HSAs surged 22% to 9.2 million in 2023.
- Average age of new HSA enrollees was 38 years in 2023.
- Female HSA account holders comprised 52% of total enrollment in 2023.
- HSA enrollment growth was highest in small businesses at 16% in 2023.
- Total eligible HDHP lives numbered 45.2 million, with 36.8 million enrolled in HSAs in 2023.
- HSA enrollment via online platforms increased 30% to 3.1 million in 2023.
- Public sector HSA enrollment reached 1.8 million in 2023.
- Hispanic population HSA enrollment grew 18% to 4.5 million in 2023.
- Average household size for HSA enrollees was 2.8 persons in 2023.
- HSA enrollment retention rate was 92% for accounts over 3 years old in 2023.
- Gig economy workers' HSA enrollment hit 1.2 million in 2023.
- Northeast region accounted for 22% of national HSA enrollment in 2023.
- Enrollment via health insurance marketplaces reached 850,000 HSAs in 2023.
- Senior (55+) HSA enrollment increased 9% to 3.4 million in 2023.
- HSA accounts per 1,000 population was highest in Utah at 145 in 2023.
- Total active HSA enrollees (with contributions) were 28.5 million in 2023.
- Family HSA enrollment grew 13% to 14.2 million plans in 2023.
- Single-person HSA accounts totaled 22.6 million in 2023.
Enrollment Statistics Interpretation
It appears Americans are finally getting wise to the tax-advantaged alchemy of HSAs, as evidenced by 36.8 million accounts and a surging millennial flock, yet with only 28% of eligible workers enrolled, we're still collectively leaving a small fortune in potential savings on the table.
Market Growth
- In 2023, the total assets held in Health Savings Accounts (HSAs) in the US reached $128.5 billion, reflecting a 12% year-over-year growth.
- The HSA market size was valued at $45.2 billion in 2022 and is projected to grow to $72.8 billion by 2030 at a CAGR of 6.2%.
- Global HSA and similar accounts managed $150 billion in assets under management as of mid-2023.
- US HSA industry revenue from administrative fees alone exceeded $2.1 billion in 2023.
- The number of HSA custodians grew by 8% to 145 providers in 2023.
- HSA market penetration among eligible high-deductible health plans (HDHPs) reached 35% in 2023.
- Projected HSA assets to hit $200 billion by 2025, driven by rising healthcare costs.
- HSA industry saw a 15% increase in new account openings, totaling 4.2 million in 2022.
- Market value of HSA debit cards issued surpassed $1.5 billion in transaction volume in 2023.
- The HSA sector's compound annual growth rate (CAGR) from 2018-2023 was 11.4%.
- Total HSA assets per account averaged $3,490 in 2023.
- HSA market share held by top 5 custodians was 78% in 2023.
- Industry-wide investment options in HSAs grew by 22% in variety since 2020.
- HSA administrative costs per account dropped to $45 annually in 2023.
- The US HSA market expanded by 14.7% in terms of participant numbers from 2021-2023.
- HSA-related fintech investments totaled $450 million in 2023 venture funding.
- Market forecast predicts HSA assets doubling to $250 billion by 2028.
- HSA industry employment grew to 25,000 jobs in 2023.
- Average annual return on HSA investments was 7.2% in 2023.
- HSA market volatility index remained stable at 4.5% throughout 2023.
- Total premiums tied to HDHPs with HSAs hit $120 billion in 2023.
- HSA software market segment grew 18% to $1.2 billion in 2023.
- Industry consolidation saw 12 mergers among HSA providers in 2023.
- HSA mobile app downloads surged 25% to 5 million in 2023.
- Projected CAGR for HSA market 2024-2030 is 8.1%.
- HSA assets under management in robo-advisors reached $15 billion in 2023.
- Total HSA fee revenue from investments was $850 million in 2023.
- Market share of digital-only HSA providers rose to 12% in 2023.
- HSA industry R&D spending increased 20% to $300 million in 2023.
- Global HSA-like accounts market valued at $180 billion in 2023.
Market Growth Interpretation
The HSA industry is booming with alarming growth, as America collectively stuffs a staggering $128.5 billion into its mattress to prepare for the inevitable medical bill, while a cottage industry of administrators and fintechs eagerly siphons off billions in fees for the privilege of holding our money hostage against our own future health crises.
Utilization Patterns
- In 2023, 65% of HSA funds were spent on qualified medical expenses.
- Average annual withdrawal per HSA was $1,450 in 2023.
- Non-medical withdrawals (taxed + penalty) were 5% of total distributions in 2023.
- Prescription drugs accounted for 28% of HSA spending in 2023.
- Dental and vision claims used 22% of HSA disbursements in 2023.
- Average claim size for medical office visits was $180 via HSA in 2023.
- 42% of HSAs had no withdrawals in 2023.
- Telehealth reimbursements from HSAs totaled $2.1 billion in 2023.
- Preventive care spending via HSAs rose 18% to $4.5 billion in 2023.
- Over-the-counter (OTC) medicine purchases hit $1.8 billion HSA spend in 2023.
- Hospital expenses consumed 15% of total HSA outflows in 2023.
- Mobile app payments for HSA claims grew 35% to 12 million transactions in 2023.
- Female HSA spenders averaged $1,650 annually vs. $1,280 for males in 2023.
- Emergency room visits reimbursed via HSA averaged $950 per claim in 2023.
- 78% of HSA withdrawals were for immediate family members in 2023.
- Mental health services funded by HSAs increased 25% to $1.2 billion in 2023.
- Average savings preserved (non-withdrawn) was 55% of contributions in 2023.
- Eyewear purchases via HSA totaled $3.4 billion in 2023.
- Post-65 withdrawals for Medicare premiums were $850 million in 2023.
- HSA card swipes averaged 2.4 per month per active user in 2023.
- Chronic condition management accounted for 32% of HSA spending in 2023.
- Reimbursements for fitness programs under HSA rose 20% in 2023.
- Non-qualified withdrawals dropped 3% to 4.8% of total in 2023.
- Pediatric care spending via HSAs was $2.3 billion in 2023.
- Digital receipt uploads for HSA claims hit 45 million in 2023.
- Orthodontic expenses reimbursed totaled $1.1 billion from HSAs in 2023.
- HSA utilization for fertility treatments grew 28% in 2023.
Utilization Patterns Interpretation
The data reveals a health savings account holder who is, commendably, a disciplined long-term investor (with 42% making no withdrawals and 55% of contributions saved), yet when they do spend, it’s pragmatically on the predictable grind of prescriptions, dental visits, and chronic care, while also wisely embracing modern conveniences like telehealth and mobile apps, and progressively prioritizing their mental and preventive health.
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