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
- 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.
- Average individual HSA balance was $3,410 at end-2022, 14% growth.
- HSAs with balances over $50,000 numbered 350,000 in 2022, holding 20% of assets.
- Average balance for accounts aged 10+ years was $18,500 in 2022.
- Investable HSA balances totaled $76 billion in 2022, 63% of total assets.
- Average cash balance in HSAs was $1,850 per account in 2022.
- Top 1% of HSAs held average $250,000+ balances, totaling $8 billion in 2022.
- Year-over-year balance growth was 22% for family HSAs in 2022.
- Average balance by age: under 30 was $1,200; 50-64 was $7,800 in 2022.
- Dormant HSAs (balance >$0, no activity) were 22% of total, avg $900 bal 2022.
- Fidelity-managed HSAs averaged $4,200 balance in 2022.
- Average rollover balance into HSAs was $5,600 in 2022 transfers.
- Mid-2023 average balance hit $3,650, projecting $3,900 year-end.
- HSAs with investments averaged $12,400 balance in 2022.
- Small employer HSAs averaged $2,800 balance vs $4,100 large in 2022.
- 55+ age group HSAs averaged $9,200 including catch-ups 2022.
- Balance growth CAGR 2006-2022 was 15.3% nominally.
- Zero-balance HSAs dropped to 15% of total in 2022 from 18% 2021.
- Average family invested balance $15,600 in 2022.
- Public sector HSA avg balance $5,100 in 2022.
- New 2022 HSAs ended year avg $1,100 balance.
- High-deductible plan HSAs avg $4,500 balance 2022.
- Millennial HSAs avg balance $2,400 up 20% 2022.
Account 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
- 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.
- Total employee contributions hit $27.5 billion in 2022, up 12% YoY.
- 78% of HSA holders made contributions in 2022, averaging $2,300 per contributing account.
- Catch-up contributions (age 55+) totaled $1.2 billion in 2022, with 1.8 million eligible accounts participating at 65% rate.
- Average monthly contributions per active HSA were $285 in 2022.
- Employee contribution rates: 65% for individuals, 72% for families in employer plans 2022.
- Total employer contributions reached $20.8 billion in 2022, 15% growth.
- In 2023 H1, contributions totaled $25.1 billion, projecting $51 billion full year.
- Average first-year contribution for new HSAs was $1,450 in 2022.
- 42% of contributors maxed out family limits ($7,300 in 2022), totaling 2.1 million accounts.
- Rollover contributions from IRAs to HSAs averaged $850 per transfer in 2022.
- Public sector employer contributions averaged $950 per family HSA in 2022.
- Contribution frequency: 55% monthly payroll deduction in 2022 employer HSAs.
- Small business (<50 ee) average employee contrib $920, up 10% YoY 2022.
- 2022 max individual limit ($3,650) reached by 28% of individual HSA holders.
- Total catch-up contribs grew 18% to $1.4 billion projected 2023.
- Average employer match rate was 75% of employee contribs in 2022.
- New millennial HSAs averaged $1,680 contribs in first year 2022.
- 35% of HSAs received no contributions in 2022, mostly dormant accounts.
- Family HSAs saw $3,450 average total contribs (emp+ee) in 2022.
- Lump-sum contributions averaged 22% of annual totals in 2022.
- Gen Z HSA contribs averaged $750 per account in 2022.
- Employer contrib caps hit by 12% of plans, averaging $1,500 family.
- 2022 Q4 contribs spiked 25% due to year-end rushes.
- Average invested HSA contrib allocation: 60% equities in 2022.
Contributions 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
- 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.
- 62% of HSAs made qualified medical withdrawals in 2022, averaging $2,100 per account.
- Withdrawal rate for family HSAs was 68%, vs 55% individuals in 2022.
- Average debit card withdrawal was $180 per transaction in 2022 HSAs.
- Post-tax non-medical withdrawals after age 65 averaged $450 per account 2022.
- 28% of withdrawals were reimbursements from prior expenses in 2022.
- Total 2023 H1 withdrawals $16.8 billion, up 11% YoY.
- Prescription drug withdrawals averaged 35% of medical claims in 2022.
- Withdrawal frequency: 45% monthly users, avg $95 per withdrawal 2022.
- Non-qualified withdrawal penalty (20%) deterred 75% of under-65 attempts 2022.
- Average dental/vision withdrawal $320 per claim in HSAs 2022.
- Check reimbursements comprised 22% of withdrawals, avg $1,200 2022.
- Hospital-related withdrawals averaged $4,500 per event in 2022 HSAs.
- 12% of HSAs had zero withdrawals despite activity in 2022.
- Rollover withdrawals to other HSAs minimal at 0.5% of total 2022.
- Age 65+ withdrawals non-penalty $2,800 avg per account 2022.
- Online reimbursement claims grew 30% to 1.2 million in 2022.
- Primary care visit withdrawals avg $150, 40% of routine claims 2022.
- Withdrawal-to-balance ratio was 32% for active HSAs in 2022.
- Telehealth withdrawals surged 50% to $120 million in 2022.
- Employer-integrated withdrawals via payroll avg $200 monthly 2022.
- Urgent care withdrawals avg $220 per visit, 15% of outpatient 2022.
- Preventive care withdrawals exempt from deductible avg $90 2022.
- 18-34 age group withdrawal rate 52%, avg $950 annual 2022.
- 72% of HSA holders under 35 used funds for medical in 2022.
Distributions 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
- 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.
- From 2018 to 2022, HSA enrollment grew at a compound annual growth rate (CAGR) of 11.2%, driven by rising HDHP adoption.
- By mid-2023, HSA account openings in the first half totaled 2.8 million, up 8% from the same period in 2022.
- The market share of HSAs held by the top 10 custodians was 78% of total accounts in 2022, totaling 27.3 million accounts.
- Employer-sponsored HSAs numbered 22.5 million in 2022, representing 64% of all HSAs.
- Individual HSAs grew by 15% to 12.4 million accounts in 2022, outpacing family HSA growth of 12%.
- HDHP enrollment among employer plans rose to 29% in 2023, correlating with a 10% HSA uptake increase.
- Total HSA participants reached 46 million in 2022 when including non-account holders eligible via HDHPs.
- HSA market penetration among eligible HDHP enrollees was 40% in 2022, up from 35% in 2020.
- New HSA openings by millennials (ages 28-43) accounted for 42% of all openings in 2022.
- The number of HSAs with investment accounts grew 18% to 8.2 million in 2022.
- From 2006 to 2022, cumulative HSA accounts grew from 1 million to 35 million, a 35x increase.
- In 2023 Q1-Q2, HSA account growth was 1.4 million new accounts, a 7% YoY rise.
- HSA custodians reported 1.9 million new accounts in 2022, with average monthly openings of 158,000.
- Family HSAs comprised 64% of total accounts in 2022, totaling 22.4 million.
- Post-ACA (2010-2022), HSA enrollment accelerated by 20% annually on average.
- By 2023, HSAs represented 18% of all employer-sponsored health benefits enrollment.
- HSA growth in small businesses (<50 employees) was 16% in 2022, vs 11% in large firms.
- Total eligible HDHP lives reached 115 million in 2022, with 35 million HSAs funded.
- HSA adoption rate among Gen Z (ages 18-27) doubled to 12% from 2019-2022.
- In 2022, 25% of new HSAs were opened via employer portals, up from 20% in 2021.
- HSA accounts per 1,000 population reached 105 in 2022, up from 92 in 2021.
- Mid-year 2023 HSA totals hit 36.4 million accounts, projecting 37.5 million year-end.
- Employer HSA contribution mandates covered 15% of plans in 2023, boosting enrollment 9%.
- HSA market expanded 14% in invested assets segment to $48 billion in 2022.
- From 2020-2022, pandemic-driven HDHP shifts added 4.5 million HSAs.
- 2022 saw 2.1 million HSAs closed, net growth of 4 million accounts.
- HSA enrollment in public sector plans grew 10% to 3.2 million in 2022.
Enrollment 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
- 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.
- 62% of HSAs were held by families with children under 18 in 2022.
- Income distribution: 45% of holders earned $50k-$100k annually in 2022.
- Gen X (44-59) held 32% of HSAs, averaging higher balances.
- 28% of holders were self-employed or individually insured in 2022.
- Regional: South held 36% of HSAs, Midwest 26% in 2022.
- 55+ holders (Baby Boomers) were 18% of accounts but 25% assets 2022.
- Women-led single HSAs grew 14% to 5.8 million in 2022.
- Average household size for family HSAs was 3.8 members 2022.
- 65% of holders had college degrees or higher in 2022 surveys.
- Urban dwellers held 58% of HSAs vs 42% suburban/rural 2022.
- Married couples represented 52% of family HSA holders 2022.
- Low-income (<$50k) participation was 22% of eligible in 2022.
- Veterans held 8% of HSAs, avg balance $4,800 in 2022.
- 42% of holders were in professional/white-collar jobs 2022.
- Hispanic/Latino holders 12% of HSAs, up 11% YoY 2022.
- Single parents with HSAs: 9% of family accounts 2022.
- High-income (>$150k) held 28% assets despite 15% accounts 2022.
- Gen Z holders tripled to 6% of new accounts in 2022.
- 71% of holders employed full-time in private sector 2022.
- African American participation 9% of HSAs in 2022.
- Retirees with HSAs 7% of total, growing 12% 2022.
- Northeast region 22% of HSAs despite 17% population 2022.
- 35% of holders had 2+ dependents in 2022.
- Blue-collar workers 18% of HSA participants 2022.
- Asian American holders 6% of accounts, higher contrib rates 2022.
- Part-time workers 11% of HSA holders 2022.
Participant 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.