The average balance in a Health Savings Account (HSA) ended at $5,336 in 2025, as reported by Devenir. However, this number falls to $4,167 when considering accounts with zero or negative balances. This distinction points towards two distinct groups of HSA users which utilize the accounts differently.
For many users, HSAs work as a reimbursement account, where funds are used soon after they are deposited to cover medical bills. On the other side, there is a rapidly growing subset of account holders who treat their HSAs as a savings tool for future healthcare expenses, particularly after retirement.
Balances in HSAs rollover indefinitely and can be invested for growth. Most holders seldom fully exploit this feature. Many HSAs have low balances; almost 22% of all 41.7 million U.S. HSAs had a zero or negative balance and 30% contained less than $500 by the close of 2025. These low balances suggest money is often deposited and swiftly spent.
In 2025, average HSA contributions were $1,829, while average withdrawals were $1,372. Contributions reached roughly $59.6 billion, while withdrawals hit $44.7 billion. Only about 25% of each contributed dollar remains in the account, while 75% is withdrawn.
Approximately 10% of all HSAs - 4.2 million out of 41.7 million accounts - contained invested assets by the end of 2025. These accounts had mean balances of $24,252, which is nearly 10 times larger than in accounts without investments. Over the past decade, HSAs containing over $10,000 surged from 599,000 to 4.1 million.
HSAs allow the use of pre-tax dollars for contributions and tax-free growth and withdrawals. As such, some financial advisors regard HSAs as the most tax-efficient long-term savings tool available. Given healthcare costs can be expensive and unpredictable, not all households can maximize HSA contributions or pay all medical bills out of pocket. However, using HSAs doesn’t have to be a binary choice. Account holders can reserve some funds for unexpected costs while investing the rest.
HSAs can serve different purposes based on an individual's stage of life or financial situation. While initially they might be used to cover immediate medical costs, as financial stability increases, more can be invested for future use. The core principle remains: money saved from HSA withdrawals may remain invested and earn tax-free growth for future healthcare expenses or potential retirement funds.