Average HSA balance hits record $5,532, and most is still cash

The average health savings account balance reached $5,532 in 2024, a record, according to new Employee Benefit Research Institute data. A year earlier it was $4,747. Most of that money never left cash. Only 18% of accountholders invested in anything beyond cash. 56% took a distribution during the year. The institute's database, covering 2011 through 2024, held 15.2 million accounts by Dec. 31. Assets totaled $53.7 billion.

More than 40% of accounts in the database were opened in 2022 or later, so a large share of owners have not had time to accumulate. The average balance comes in below the $8,050 out-of-pocket maximum for individual HSA-eligible coverage. It is roughly a third of the $16,100 family maximum. The 44% of accountholders who made no withdrawal leave contributions and investment gains to compound. The record average is real, and the account base is young.

Paul Fronstin, who directs health benefits research at EBRI, puts it plainly: people use HSAs differently the longer they own them. Longtime accountholders accumulate larger balances, contribute more, and are more likely to invest. That tenure effect is the quiet argument for treating HSAs as a retirement account with a health-care deductible attached. The balances that matter decades from now are the ones that survived the early spending years.

The triple tax advantage is only fully realized when contributions approach the statutory maximum, withdrawals are limited to actual medical costs, and the balance is invested instead of held in cash. EBRI says most accountholders instead use the account to pay current expenses, leaving the tax benefit mostly untouched. Plan sponsors should watch the 18% who invest, not the record balance. As the 2022-and-later cohort ages, the share that migrates out of cash will show whether the cash-heavy pattern was circumstance or habit. The report doesn't say what the invested 18% own, only that they left cash. That is the next question for sponsors building HSA menus.