Report Shows Shift in How and Where Workers Are Using HSA Funds

E-commerce brands have stepped into the healthcare marketplace — and your employees are here for it, according to one recent study.

The eighth annual spend report on health savings accounts (HSA) from benefits provider Lively revealed transactions through this total rewards (TR) offering are shifting. While hospitals and health systems still account for the largest share of spending in dollars, consumers are swiping their HSA debit cards with consumer health brands and online retail platforms far more often.

Key findings from the report include:

• Amazon is now a top destination for HSA holders to buy health and wellness products with their funds.
• Spending at online and digital-first merchants increased (Hims & Hers, Ro Health, Warby Parker and 1-800 Contacts all saw spikes).
• A major spending spike occurred with manufacturers and platforms tied to glucagon-like peptide-1 (GLP-1) medications. Spending for such products through Lilly increased 5,610% year-over-year in 2025, while Hims & Hers saw a 134% increase.
• Mental health support platforms such as Headway, BetterHelp and therapy-focused apps such as Ivy also saw increased spending in 2025.
• Prescriptions continued to be the most frequent usage, in terms of total debit card swipes.

The report stated merchant mix showed consumers are choosing access, convenience, transparency and digital-first care models as they increasingly utilize their HSA as an everyday healthcare wallet.

“Healthcare spending is becoming more personal, more digital and more frequent,” Lively co-founder and chief operating officer Shobin Uralil said in a press release. “HSAs are increasingly the financial layer connecting consumers to the health brands and services they rely on most.”

Usage Shifts with Spending

Another interesting statistic from the report was that HSA balances have grown along with related spending.

It appears the shift toward spending on proactive care (which helps limit or prevent larger healthcare costs down the road) also is enabling an increasing number of workers to treat their HSAs as both a savings and investment vehicle.

“Over recent years, HSAs have evolved from niche tax-advantaged accounts into a central tool for cost management and employee financial protection,” said Nicole Delimitros, the senior vice president of employee health and benefits strategic initiatives and partnerships at advisory firm Marsh McLennan. “Employees treat HSAs not only as short‑term payment accounts but increasingly as portable, long‑term savings and investment vehicles.”

Trends show HSAs increasingly serve as a rolling reserve to cover deductibles and pharmacy costs as high-deductible health plans (HDHPs) become more common. According to Delimitros, this indicates workers are managing larger and more variable out‑of‑pocket exposures.

“Higher pharmacy inflation and specialty drug utilization magnify the need for accessible, tax‑favored funds that employees can control, which also exposes gaps for those who start with zero balances,” she said.

The behavioral implication is twofold — employees value predictable support up front, and they also benefit from education on using HSA dollars strategically (think preventive care, generics, price shopping and investing balances).

“For employers, these spending patterns highlight the need to integrate HSAs into broader wellness and cost‑containment strategies, aligning pharmacy benefit design, care navigation and targeted support to the populations that are depleting balances most quickly,” Delimitros said.

According to Jake Spiegel, a research associate at the Employee Benefits Research Institute, the nonprofit’s data indicates 23% of account holders view their HSA as a spending vehicle, 61% view it as a savings vehicle and 31% view it as an investment vehicle.

“The data reflects a workforce managing both immediate affordability pressures and long-term financial risk,” agreed WorldatWork content director Alicia Scott-Wears. “Continued debit card use highlights ongoing medical cost strain, while investment growth signals a desire for financial resilience amid uncertainty about healthcare expenses and retirement security.”

HSAs Are a Core Benefit, Not an Add-On

TR leaders should treat HSAs as a foundational element of the health benefit architecture, not an optional add‑on, said Delimitros.

“Consider expanding employer contributions — whether flat, tiered by family status or matched to employee deferrals — to seed accounts and reduce financial friction for care-seeking, particularly for lower-paid or part‑time workers who are least likely to have balances,” she said. “Standardizing a baseline employer contribution sends a clear signal of investment in employee well-being, promotes earlier engagement with high-value care and often reduces downstream medical cost-avoidance behavior.”

The research is clear, Spiegel added — employer contributions influence HSA use for the better.

“Accountholders who receive an employer contribution tend to have higher total contributions, larger balances and are more likely to also invest,” he said.

Scott-Wears added that TR leaders also should design plans and contributions that support diverse employee needs, whether that’s covering near-term care or enabling long-term wealth-building, while integrating HSAs more deliberately into broader financial wellness and retirement strategies.

“Today, HSAs are increasingly viewed as a cornerstone of long-term financial planning,” she said. “Rising healthcare costs, higher plan deductibles, improved investment access, and greater awareness and education of HSAs’ triple tax advantage are driving a clear shift from short-term spending toward long-term savings. Nearly half of all HSA assets are now invested, even though only a minority of account holders invest, underscoring how powerful the shift has become.”

Simple, Targeted and Practical

The experts interviewed for this article agreed that effective HSA communication should be simple, segmented and action-oriented. To move forward:

• Clarify the account’s tax advantages, portability, eligible expenses, employer contribution mechanics and timing, and how HSAs interact with plan choices (such as HDHPs, flexible spending accounts and health reimbursement accounts). “The ultimate goal is behavior change — drive enrollment, encourage pre‑funding and regular contributions, promote use of preventive care, and help employees treat HSAs as both near‑term expense liquidity and long‑term savings,” Delimitros said.
• Measure account adoption, average balances and claims patterns to calibrate contribution levels, and targeted supports where they’ll have the greatest impact, Delimitros added. “Clear, consistent messaging that connects HSA features to everyday decision‑making — such as prescription choices, provider selection and elective care timing — will increase engagement and reduce avoidable care delays that create cost and health risk,” she said.

The goal isn’t just enrollment — it’s confidence.

“When employees understand when to spend, when to save, and how HSAs fit into their overall health and financial picture, they’re far more likely to realize the full value of the benefit,” Delimitros said.

Editor’s Note: Additional Content

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