HSA Enrollment is Growing…or Is It? - American Society of Employers - Kevin Marrs

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HSA Enrollment is Growing…or Is It?

As of January 2017, 52 health insurance providers reported 21.8 million HSA/HDHP enrollees, up from 20.2 million in 2016.  This is according to a recently released survey from America’s Health Insurance Plans (AHIP) who also reported a 9.2% increase in enrollment in HSA/HDHP from 2016 to 2017 in an analysis of a constant sample of 45 health plans.

In a separate survey from Devenir, a national provider of investment solutions for health savings accounts (HSAs), data showed that the number of HSA accounts surpassed 22 million in 2017.  These accounts held about $45.2 billion in assets, a year-over-year increase of 22% for HSA assets and 11% for accounts for the year ending December 31, 2017.

A health savings account (HSA) is a type of savings account that employees contribute to on a pre-tax basis to pay for qualified medical expenses. These funds, combined with potential contributions from the employer, can be used to pay for deductibles, copayments, coinsurance, and some other expenses.  An HSA can be used in a High Deductible Health Plan (HDHP) — generally any health plan with a deductible of at least $1,350 for an individual or $2,700 for a family.

The Devenir study revealed that in 2017, 21% of all HSA dollars contributed came from an employer. The average contribution was $604.  Employees contributed an average of $1,921.

For all the positive news regarding the growth of HSA’s, the Employee Benefit Research Institute (EBRI) suggested earlier this year that HSA enrollment may in fact be trending down.  Their analysis of five separate HSA surveys, including those conducted by AHIP and Devenir, find that there was very little growth in HSA-eligible health plan enrollment from 2014 to 2017.

One issue raised in the analysis by EBRI is the differences in studies that focus on the number of HSA accounts versus actual enrollment in HSA eligible health plans.  The authors of the EBRI analysis point out that many HSA’s are unfunded and not receiving contributions.  As a result, they suggest that simply looking at the number of accounts may not be a good indicator of the health of the HSA market.  However, in their recent analysis, Devenir reported a decline in the number of unfunded HSA accounts.

If there is a drag on the growth of HSA enrollment there may be several culprits.  Some point to the improving economy where employers may be more cautious to move to HSA-eligible health plans.  Others point to the potential adverse impact of HSA’s on use of preventative care or medication adherence.

Still, there is strong evidence that HSA’s are here to stay, and Congress has made some recent efforts to expand access to them and increase their flexibility.  The American Society of Employers has begun collecting data for its 2018 Healthcare Insurance Benefits Survey.  This survey will examine a wide array of health benefits including HSA’s.  The survey is open to member companies.  For more information or to access the survey, please contact the ASE Survey team as [email protected].


Sources: devenir.com, ebri.org, shrm.org


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