EBRI Survey: 61% View HSA as Savings Account
As rising health care costs impact retirement savings, EBRI found two-thirds of survey respondents used a health savings account in the last year for near-term spending.
Health savings accounts may have tax advantages for long-term savings, but most respondents in a new survey published Monday by the nonprofit Employee Benefit Research Institute reported using an HSA for immediate costs.
When the 2025 EBRI/Greenwald Research Consumer Engagement in Health Care Survey asked HSA owners how they used their accounts, 67% said they were for out-of-pocket expenses from the past year or near term. Only 35% reported saving in their HSA for health care costs in retirement, and 28% said they had invested their account funds.
Some 31% of surveyed HSA owners viewed their accounts as a tool for investments, while 61% viewed them as savings accounts, 23% viewed them as checking accounts and 9% did not pick those options.
The underutilization of HSA accounts for long-term savings reflects a growing concern about health care costs. Of EBRI’s 2,001 total survey respondents, four in 10 said their health care costs increased in the past year. Among those who spent more on health care, 26% said they had reduced retirement savings in response, and 15% said they planned to take a loan or withdraw from their 401(k) or individual retirement account to cover health-related expenses. EBRI found that 55% of respondents reduced discretionary spending, while 44% decreased contributions to other savings and 35% increased credit card debt.
The most common reason for delaying medical care in the past 12 months, cited by 45%, was not having or not wanting to spend the money.
“Even among people with private coverage, rising health care costs are affecting household budgets in very real ways,” said Paul Fronstin, EBRI’s director of health benefits research, in a statement. “When higher health care costs lead people to cut spending, struggle with bills or reduce retirement contributions, it highlights how affordability shapes both access to care and longer-term financial security.”
Employers could guide workers on health-related investments, as 60% of EBRI respondents said they were insured through their workplace. In addition, 54% of HSA owners surveyed said they opened their account to take advantage of employer contributions. Also, 59% of enrollees in high-deductible health plans, which are required when contributing to an HSA, said they were more likely to use their employers’ benefits guide, and 44% said they used the online benefits portal for their workplace plans, compared with 47% of enrollees in traditional health plans who used the benefits guide and 38% who used the benefits portal.
Others reasons for an HSA included saving for future expenses, shared by 51% of surveyed HSA owners, and having an exclusive account for health care costs, shared by 47%. Only 34% said they had the account to save for health care costs in retirement, and 23% indicated general retirement savings as a reason for having an HSA. In 2024, the largest share of respondents—56%—said they had an HSA to reduce their tax burden, but only 43% of respondents shared that reason in 2025.
The Consumer Engagement in Health Care Survey reported responses from 2,001 privately insured adults aged 21 to 64 from October 13 through November 8, 2025, including 74% who were full-time employees and 63% who reported an annual household income of at least $100,000.