Amidst soaring healthcare costs, Health Savings Accounts are experiencing explosive growth, with assets swelling to over $120 billion and more than 35 million Americans now using them to build a powerful financial buffer for their medical future.
Key Takeaways
- In 2022, the total number of Health Savings Accounts (HSAs) reached 35.0 million, marking a 13% year-over-year increase from 31.0 million in 2021.
- HSA assets under management grew to $120.4 billion by the end of 2022, a 19% increase from $101.5 billion at the end of 2021.
- The number of HSAs linked to high-deductible health plans (HDHPs) increased by 12% in 2022, reaching approximately 29.5 million accounts.
- Total contributions to HSAs reached $48.3 billion in 2022, a 14% increase from $42.4 billion in 2021.
- Average annual employee contributions to HSAs were $1,039 for individuals and $1,994 for families in 2022.
- Employer contributions averaged $572 per employee for individual HSAs and $1,282 for family coverage in 2022.
- The average HSA balance across all accounts was $3,437 at year-end 2022.
- Average family HSA balance reached $8,974 in 2022, up 16% from 2021.
- Median HSA balance was $1,231 in 2022, reflecting skew from high-balance accounts.
- Total qualified withdrawals from HSAs were $32.1 billion in 2022.
- Average annual withdrawal per account was $1,250 for medical expenses in 2022.
- Non-qualified withdrawals totaled $1.8 billion in 2022, 5.3% of total distributions.
- Average age of HSA holder was 45 years in 2022.
- 54% of HSA holders were male, 46% female in 2022 data.
- Millennials (28-43) represented 38% of HSA account holders in 2022.
HSAs are growing rapidly in both total accounts and assets under management.
Account Balances
1The average HSA balance across all accounts was $3,437 at year-end 2022.
Verified2Average family HSA balance reached $8,974 in 2022, up 16% from 2021.
Verified3Median HSA balance was $1,231 in 2022, reflecting skew from high-balance accounts.
Verified4Average individual HSA balance was $3,410 at end-2022, 14% growth.
Directional5HSAs with balances over $50,000 numbered 350,000 in 2022, holding 20% of assets.
Single source6Average balance for accounts aged 10+ years was $18,500 in 2022.
Verified7Investable HSA balances totaled $76 billion in 2022, 63% of total assets.
Verified8Average cash balance in HSAs was $1,850 per account in 2022.
Verified9Top 1% of HSAs held average $250,000+ balances, totaling $8 billion in 2022.
Directional10Year-over-year balance growth was 22% for family HSAs in 2022.
Single source11Average balance by age: under 30 was $1,200; 50-64 was $7,800 in 2022.
Verified12Dormant HSAs (balance >$0, no activity) were 22% of total, avg $900 bal 2022.
Verified13Fidelity-managed HSAs averaged $4,200 balance in 2022.
Verified14Average rollover balance into HSAs was $5,600 in 2022 transfers.
Directional15Mid-2023 average balance hit $3,650, projecting $3,900 year-end.
Single source16HSAs with investments averaged $12,400 balance in 2022.
Verified17Small employer HSAs averaged $2,800 balance vs $4,100 large in 2022.
Verified1855+ age group HSAs averaged $9,200 including catch-ups 2022.
Verified19Balance growth CAGR 2006-2022 was 15.3% nominally.
Directional20Zero-balance HSAs dropped to 15% of total in 2022 from 18% 2021.
Single source21Average family invested balance $15,600 in 2022.
Verified22Public sector HSA avg balance $5,100 in 2022.
Verified23New 2022 HSAs ended year avg $1,100 balance.
Verified24High-deductible plan HSAs avg $4,500 balance 2022.
Directional25Millennial HSAs avg balance $2,400 up 20% 2022.
Single sourceAccount Balances Interpretation
The stark reality is that while a fortunate few are treating their HSAs as serious retirement vehicles, the median saver is still grappling with a balance that wouldn't cover a single deductible, revealing a system where long-term wealth building is the exception rather than the rule.
Contributions
1Total contributions to HSAs reached $48.3 billion in 2022, a 14% increase from $42.4 billion in 2021.
Verified2Average annual employee contributions to HSAs were $1,039 for individuals and $1,994 for families in 2022.
Verified3Employer contributions averaged $572 per employee for individual HSAs and $1,282 for family coverage in 2022.
Verified4Total employee contributions hit $27.5 billion in 2022, up 12% YoY.
Directional578% of HSA holders made contributions in 2022, averaging $2,300 per contributing account.
Single source6Catch-up contributions (age 55+) totaled $1.2 billion in 2022, with 1.8 million eligible accounts participating at 65% rate.
Verified7Average monthly contributions per active HSA were $285 in 2022.
Verified8Employee contribution rates: 65% for individuals, 72% for families in employer plans 2022.
Verified9Total employer contributions reached $20.8 billion in 2022, 15% growth.
Directional10In 2023 H1, contributions totaled $25.1 billion, projecting $51 billion full year.
Single source11Average first-year contribution for new HSAs was $1,450 in 2022.
Verified1242% of contributors maxed out family limits ($7,300 in 2022), totaling 2.1 million accounts.
Verified13Rollover contributions from IRAs to HSAs averaged $850 per transfer in 2022.
Verified14Public sector employer contributions averaged $950 per family HSA in 2022.
Directional15Contribution frequency: 55% monthly payroll deduction in 2022 employer HSAs.
Single source16Small business (<50 ee) average employee contrib $920, up 10% YoY 2022.
Verified172022 max individual limit ($3,650) reached by 28% of individual HSA holders.
Verified18Total catch-up contribs grew 18% to $1.4 billion projected 2023.
Verified19Average employer match rate was 75% of employee contribs in 2022.
Directional20New millennial HSAs averaged $1,680 contribs in first year 2022.
Single source2135% of HSAs received no contributions in 2022, mostly dormant accounts.
Verified22Family HSAs saw $3,450 average total contribs (emp+ee) in 2022.
Verified23Lump-sum contributions averaged 22% of annual totals in 2022.
Verified24Gen Z HSA contribs averaged $750 per account in 2022.
Directional25Employer contrib caps hit by 12% of plans, averaging $1,500 family.
Single source262022 Q4 contribs spiked 25% due to year-end rushes.
Verified27Average invested HSA contrib allocation: 60% equities in 2022.
VerifiedContributions Interpretation
Americans are collectively embracing health savings accounts with the fervor of bargain hunters during a once-in-a-lifetime sale, funneling nearly $50 billion into their future well-being, while still leaving a concerning chunk of accounts gathering dust.
Distributions and Withdrawals
1Total qualified withdrawals from HSAs were $32.1 billion in 2022.
Verified2Average annual withdrawal per account was $1,250 for medical expenses in 2022.
Verified3Non-qualified withdrawals totaled $1.8 billion in 2022, 5.3% of total distributions.
Verified462% of HSAs made qualified medical withdrawals in 2022, averaging $2,100 per account.
Directional5Withdrawal rate for family HSAs was 68%, vs 55% individuals in 2022.
Single source6Average debit card withdrawal was $180 per transaction in 2022 HSAs.
Verified7Post-tax non-medical withdrawals after age 65 averaged $450 per account 2022.
Verified828% of withdrawals were reimbursements from prior expenses in 2022.
Verified9Total 2023 H1 withdrawals $16.8 billion, up 11% YoY.
Directional10Prescription drug withdrawals averaged 35% of medical claims in 2022.
Single source11Withdrawal frequency: 45% monthly users, avg $95 per withdrawal 2022.
Verified12Non-qualified withdrawal penalty (20%) deterred 75% of under-65 attempts 2022.
Verified13Average dental/vision withdrawal $320 per claim in HSAs 2022.
Verified14Check reimbursements comprised 22% of withdrawals, avg $1,200 2022.
Directional15Hospital-related withdrawals averaged $4,500 per event in 2022 HSAs.
Single source1612% of HSAs had zero withdrawals despite activity in 2022.
Verified17Rollover withdrawals to other HSAs minimal at 0.5% of total 2022.
Verified18Age 65+ withdrawals non-penalty $2,800 avg per account 2022.
Verified19Online reimbursement claims grew 30% to 1.2 million in 2022.
Directional20Primary care visit withdrawals avg $150, 40% of routine claims 2022.
Single source21Withdrawal-to-balance ratio was 32% for active HSAs in 2022.
Verified22Telehealth withdrawals surged 50% to $120 million in 2022.
Verified23Employer-integrated withdrawals via payroll avg $200 monthly 2022.
Verified24Urgent care withdrawals avg $220 per visit, 15% of outpatient 2022.
Directional25Preventive care withdrawals exempt from deductible avg $90 2022.
Single source2618-34 age group withdrawal rate 52%, avg $950 annual 2022.
Verified2772% of HSA holders under 35 used funds for medical in 2022.
VerifiedDistributions and Withdrawals Interpretation
Americans are getting a masterclass in medical budgeting, skillfully navigating their HSAs with the precision of a surgeon—spending an average of $1,250 annually on qualified care while largely avoiding the 20% penalty for missteps—though they still flinch at an average $4,500 hospital bill and find that prescriptions and primary care visits consume a hefty share of their carefully saved funds.
Enrollment and Market Growth
1In 2022, the total number of Health Savings Accounts (HSAs) reached 35.0 million, marking a 13% year-over-year increase from 31.0 million in 2021.
Verified2HSA assets under management grew to $120.4 billion by the end of 2022, a 19% increase from $101.5 billion at the end of 2021.
Verified3The number of HSAs linked to high-deductible health plans (HDHPs) increased by 12% in 2022, reaching approximately 29.5 million accounts.
Verified4From 2018 to 2022, HSA enrollment grew at a compound annual growth rate (CAGR) of 11.2%, driven by rising HDHP adoption.
Directional5By mid-2023, HSA account openings in the first half totaled 2.8 million, up 8% from the same period in 2022.
Single source6The market share of HSAs held by the top 10 custodians was 78% of total accounts in 2022, totaling 27.3 million accounts.
Verified7Employer-sponsored HSAs numbered 22.5 million in 2022, representing 64% of all HSAs.
Verified8Individual HSAs grew by 15% to 12.4 million accounts in 2022, outpacing family HSA growth of 12%.
Verified9HDHP enrollment among employer plans rose to 29% in 2023, correlating with a 10% HSA uptake increase.
Directional10Total HSA participants reached 46 million in 2022 when including non-account holders eligible via HDHPs.
Single source11HSA market penetration among eligible HDHP enrollees was 40% in 2022, up from 35% in 2020.
Verified12New HSA openings by millennials (ages 28-43) accounted for 42% of all openings in 2022.
Verified13The number of HSAs with investment accounts grew 18% to 8.2 million in 2022.
Verified14From 2006 to 2022, cumulative HSA accounts grew from 1 million to 35 million, a 35x increase.
Directional15In 2023 Q1-Q2, HSA account growth was 1.4 million new accounts, a 7% YoY rise.
Single source16HSA custodians reported 1.9 million new accounts in 2022, with average monthly openings of 158,000.
Verified17Family HSAs comprised 64% of total accounts in 2022, totaling 22.4 million.
Verified18Post-ACA (2010-2022), HSA enrollment accelerated by 20% annually on average.
Verified19By 2023, HSAs represented 18% of all employer-sponsored health benefits enrollment.
Directional20HSA growth in small businesses (<50 employees) was 16% in 2022, vs 11% in large firms.
Single source21Total eligible HDHP lives reached 115 million in 2022, with 35 million HSAs funded.
Verified22HSA adoption rate among Gen Z (ages 18-27) doubled to 12% from 2019-2022.
Verified23In 2022, 25% of new HSAs were opened via employer portals, up from 20% in 2021.
Verified24HSA accounts per 1,000 population reached 105 in 2022, up from 92 in 2021.
Directional25Mid-year 2023 HSA totals hit 36.4 million accounts, projecting 37.5 million year-end.
Single source26Employer HSA contribution mandates covered 15% of plans in 2023, boosting enrollment 9%.
Verified27HSA market expanded 14% in invested assets segment to $48 billion in 2022.
Verified28From 2020-2022, pandemic-driven HDHP shifts added 4.5 million HSAs.
Verified292022 saw 2.1 million HSAs closed, net growth of 4 million accounts.
Directional30HSA enrollment in public sector plans grew 10% to 3.2 million in 2022.
Single sourceEnrollment and Market Growth Interpretation
Americans are sprinting towards health savings accounts with the fervor of someone who just saw their medical bill, as evidenced by a 13% surge in accounts to 35 million and a 19% jump in assets to $120.4 billion in 2022, suggesting we've all collectively decided to marry our high-deductible health plans and invest in our own well-being, one tax-advantaged dollar at a time.
Participant Demographics
1Average age of HSA holder was 45 years in 2022.
Verified254% of HSA holders were male, 46% female in 2022 data.
Verified3Millennials (28-43) represented 38% of HSA account holders in 2022.
Verified462% of HSAs were held by families with children under 18 in 2022.
Directional5Income distribution: 45% of holders earned $50k-$100k annually in 2022.
Single source6Gen X (44-59) held 32% of HSAs, averaging higher balances.
Verified728% of holders were self-employed or individually insured in 2022.
Verified8Regional: South held 36% of HSAs, Midwest 26% in 2022.
Verified955+ holders (Baby Boomers) were 18% of accounts but 25% assets 2022.
Directional10Women-led single HSAs grew 14% to 5.8 million in 2022.
Single source11Average household size for family HSAs was 3.8 members 2022.
Verified1265% of holders had college degrees or higher in 2022 surveys.
Verified13Urban dwellers held 58% of HSAs vs 42% suburban/rural 2022.
Verified14Married couples represented 52% of family HSA holders 2022.
Directional15Low-income (<$50k) participation was 22% of eligible in 2022.
Single source16Veterans held 8% of HSAs, avg balance $4,800 in 2022.
Verified1742% of holders were in professional/white-collar jobs 2022.
Verified18Hispanic/Latino holders 12% of HSAs, up 11% YoY 2022.
Verified19Single parents with HSAs: 9% of family accounts 2022.
Directional20High-income (>$150k) held 28% assets despite 15% accounts 2022.
Single source21Gen Z holders tripled to 6% of new accounts in 2022.
Verified2271% of holders employed full-time in private sector 2022.
Verified23African American participation 9% of HSAs in 2022.
Verified24Retirees with HSAs 7% of total, growing 12% 2022.
Directional25Northeast region 22% of HSAs despite 17% population 2022.
Single source2635% of holders had 2+ dependents in 2022.
Verified27Blue-collar workers 18% of HSA participants 2022.
Verified28Asian American holders 6% of accounts, higher contrib rates 2022.
Verified29Part-time workers 11% of HSA holders 2022.
DirectionalParticipant Demographics Interpretation
The typical American HSA holder in 2022 was a college-educated, full-time professional parent in their mid-forties, living in the South or an urban area, who was squarely in the sandwich generation, juggling their own health savings with the needs of their family while being financially savvy enough to know a good tax-advantaged deal when they saw one.