Study: 55% in U.S. with health savings accounts don't contribute to them

Some 22 million Americans have a HSA, and the balances of these accounts total more than $60 billion. Photo by TBIT/Pixabay
Some 22 million Americans have a HSA, and the balances of these accounts total more than $60 billion. Photo by TBIT/Pixabay

July 17 (UPI) -- One in three Americans do not have a health savings account, and more than half who do haven't contributed to it in more than a year, according to an analysis published Friday by JAMA Network Open.

Nearly one-third of people enrolled in a high-deductible health plan reported that they couldn't afford contributing to a health savings account, the researchers said.


"Health savings accounts can be important tools to help high-deductible health plan enrollees afford needed health care," study co-author Dr. Jeffrey T. Kullgren told UPI.

"As both the number of Americans in high-deductible health plans and healthcare costs continue to rise, our results suggest that few ... are using health savings accounts to save for healthcare, despite the major challenges they often face in affording needed health care services," said Kullgren, an assistant professor of internal medicine and health management and policy at the University of Michigan.


Health savings accounts, or HSAs, were created for people covered by high-deductible health insurance plans as part of the Medicare Prescription Drug, Improvement and Modernization Act in 2003, according to the U.S. Treasury Department.

HSAs allow consumers with significant out-of-pocket costs to set aside funds for medical expense, with the money not subject to federal income tax.

Some 22 million Americans have an HSA, and balances of these accounts total more than $60 billion, according to America's Health Insurance Plan, a lobbying group and trade association for health insurance providers.

For their research, Kullgren and his colleagues surveyed more than 1,600 American adults enrolled in high-deductible insurance plans on their use of HSAs.

They found 33% said they did not have an HSA, including just over 70% of those who obtained their insurance through an Affordable Care Act health insurance exchange, the researchers said.

Slightly more than 36% of respondents insured through employers who offered only one health insurance option reported having an HSA, according to the researchers.

Overall, 55% of respondents with an HSA indicated that they had not made a contribution to their account in the 12 months before the survey, the researchers said.


Among high-deductible health plan enrollees with an HSA, those with at least a master's degree -- 46% -- or who reported having a high level of "health insurance literacy" -- 47% -- were less likely to have made no HSA contributions, they said.

Among those with an HSA, 37% said they hadn't "considered" contributing, while 32% said they couldn't afford to, according to the researchers.

"It's important for employers, health plans, and health systems to explore new ways to help more high-deductible health plan enrollees take up and contribute to HSAs," Kullgren said.

"Money in HSAs are one important strategy to help [people] overcome the challenges of their high deductibles, [particularly] individuals with chronic conditions."

Kullgren and his colleagues did not ask respondents who had contributed to an HSA about how they used the money.

An analysis released in May 2019 by the Employee Benefit Research Institute, however, found that people with $3,000 or more in their HSAs at the beginning of the year in 2016 were more likely to visit their primary care doctors or specialists.

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