HSA Limits Rise, but Frustrated Users Leave Money Behind

As health savings account contribution limits rise for 2026, a national survey by financial technology company InComm Benefits, a division of InComm Payments, found that many account holders were missing out on the full value of their accounts—not due to lack of intent, but because of ongoing usability challenges.

When employees use their HSA regularly, they are more likely to contribute funds, which, in turn, increases tax savings for both employee and employer, according to the survey. Despite that mutual benefit, many employers may not realize that their employees are not only frustrated with the HSA experience, but also leaving money on the table.

InComm Benefits’ survey of 1,227 HSA users conducted in May found that although most accountholders viewed their accounts as a spending tool, rather than an investment vehicle, many failed to submit reimbursements for eligible out-of-pocket health and wellness expenses. The company, which markets an automation-driven debit card and mobile app for HSAs, learned that about half of respondents skipped reimbursement because the process was difficult. While nearly all participants estimated they spent less than $2,000 per year on eligible expenses, an analysis of actual behavior showed the average to be closer to $4,500—more than twice what users believed they were spending.

“This disconnect between the promise of HSAs and how employees actually experience them is substantial,” said David Etling, a senior vice president and general manager at InComm Benefits, in a statement. “While most account holders see their HSA as a spending tool for everyday care, many are running into barriers that stop them from using their funds. That trend leaves money behind for both employees using the HSA and their employer who contributes to it.”

Simplified Tools, Rewards Could Drive Engagement

User frustration at the point of purchase emerged as a key issue. More than half of users reported having transactions on eligible items declined at checkout when using their HSA-connected card. Additionally, nearly two-thirds avoided using the account when they were unsure whether an expense qualified. This uncertainty led to worse outcomes: 40% of respondents said they had delayed medical care because they could not afford it at the time.

Nearly all respondents said they would be more likely to use their HSA if purchases were automatically sorted by eligibility, eliminating the need to save receipts or second-guess reimbursement. Sixty-one percent said they would be more likely to engage with their HSA if it included cashback rewards for eligible purchases.

“Employees are trying to do the right thing. They’re setting aside money and budgeting for care, but many of the tools aren’t keeping up,” Etling said in the statement. “A single frustrating experience at checkout can discourage people from using the benefit at all. If we want HSAs to deliver on their promise, we have to make them easier to trust and use.”