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80% of HSA Account Holders Stopped or Decreased Investing in 2021

Lively’s second annual HSA Account Holder Insights report shows that Americans stopped investing their HSA dollars to save for short-term healthcare expenses due to the ongoing pandemic

Lively, Inc., creators of the modern Health Savings Account (HSA), today released their second annual HSA Account Holder Insight report. The report breaks HSA account holders into seven distinct personas based on saving, spending, and investing data, giving a view into how consumers are using their HSA funds. Findings show that investing fell sharply for the 80% of account holders who do not already heavily invest their HSA funds. This indicates that COVID-19, unemployment, and the worry caused by both, continue to prevent Americans from achieving the long-term benefits of using an HSA to save for unexpected health events and the high cost of healthcare in retirement.

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Lively 2021 HSA Persona Report (Graphic: Business Wire)

Lively 2021 HSA Persona Report (Graphic: Business Wire)

“We knew that Americans were withdrawing funds from their IRAs and 401(k)s due to the pandemic,” said Shobin Uralil, COO and Co-Founder of Lively. “But this sharp decline in HSA investing shows just how much COVID-19 has threatened the confidence of the millions of people currently saving for retirement. People need more personalized and consumer-friendly tools in their hands to help them get back on track and prepare for future health events.”

Other key findings of the HSA Account Holder Insight report show:

  1. The majority of HSA account holders are using their accounts to focus on yearly and expected tax-advantaged healthcare spending — and are spending nearly as fast as they contribute. They take about $1,700 in distributions annually, leaving them an average account balance of just over $1,000 in assets.
  2. The most investment-savvy HSA account holders are focused on maximizing their HSAs for retirement. At an average age of 59, these people had a balance of over $36,000, with 96 percent of those assets invested. This account balance grew 11 percent, up from $33,000 in 2020, due to strong performance in investment markets.
  3. Cash balances remained flat from 2020, but average spend increased for some groups and decreased for others. Cash balances remained at similar levels from last year, consistent with industry-wide findings from Employee Benefit Research Institute and Devenir. However, distinct from these industry reports, we found that average distributions increased for persona groups who are actively using their HSA as a vehicle for health spending and decreased for those who are more focused on retirement savings.
  4. Debit card spending fell slightly in 2021. Overall, while visits to primary care doctors have nearly returned to pre-pandemic levels, according to the Commonwealth fund, Americans are still putting off visits to specialists.1 However, HSA users are spending on non-doctor’s office expenses, including HSA-eligible over-the-counter products, which were expanded under the CARES Act.
  5. Families have higher HSA cash balances and utilize HSA investments more than individuals. Families have an average HSA balance of about $7,500 compared to $4,300 for individuals. For those who invest, families have an average investment balance of about $12,000 compared to just under $7,000 for individuals. Thirty-three percent of families are investors, compared to 27 percent of individuals.
  6. Individual accounts had higher balances, in both cash and investments, than employer-sponsored accounts. Individuals had an average account balance of $6,543, compared to $3,356 for employer-sponsored accounts. Average cash balances were $3,144 compared to $2,567, and average investment balances were $9,721 compared to $6,005, respectively.


Lively compiled 13 account traits from 50,000 randomly selected Health Savings Accounts (HSA) for this study, including accounts with and without active contributions. With this information, Lively’s data science team used a machine learning k-means user clustering approach (vector quantization) to organize and delineate the optimal number of HSA personas based on our entire data set of anonymous HSA account holders.

About Lively

Lively is the modern HSA experience built for—and by—those seeking stability in the ever-shifting healthcare landscape. By harnessing modern innovation and deep industry expertise, Lively is committed to bridging today’s savings with tomorrow's unknowns. Unlike traditional institutions hindered by bureaucracy, Lively’s commitment extends beyond initial set up to providing dedicated, ongoing support and education for every step. So each HSA can reach its maximum potential with minimal headache. Lively is headquartered in San Francisco, CA with additional offices in Boise, ID. For more information, please visit or follow us on Twitter (@LivelyHSA). 

1 The Impact of COVID-19 on Outpatient Visits in 2020: Visits Remained Stable, Despite a Late Surge in Cases, Commonwealth Fund, February 22, 2021.


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