HSA balances hit a record. Most accountholders still hold cash.

The average health savings account balance reached $5,532 in 2024, the highest figure in the 13 years of data the Employee Benefit Research Institute has collected. The number that matters more to plan sponsors: only 18% of accountholders have invested any money beyond cash.

EBRI published the numbers in "Trends in Health Savings Account Balances, Contributions, Distributions and Investments, 2011–2024," a database study PLANADVISER reported this week. Across the database, 56% of accountholders took a distribution in 2024. Among those who did, the average withdrawal was $1,870, up slightly from $1,801 in 2023 but below the 2010s level after inflation.

Contributions run the same way. The average employee put in $2,308 in 2024; the average employer added $727, for a combined $3,035. The tax code allowed individuals to contribute up to $4,150 and families up to $8,300. Adjusted for inflation, both employer and employee contributions were higher in the 2010s than they are now. The pattern suggests most participants are not using HSAs as retirement vehicles.

The typical balance also sits below the out-of-pocket maximum in HSA-qualified plans: $8,050 for individual coverage and $16,100 for family coverage in 2024. A family facing that exposure is not likely to treat $5,532 as money free to invest.

The investing minority is growing. The share of accountholders with assets beyond cash has climbed for eight straight years, from 5% in 2017 to 18% in 2024. Among those who do invest, older accounts hold a larger share of their assets in investments: 78% to 92% for accounts opened in 2016 or earlier, versus 57% to 65% for accounts opened between 2020 and 2024. Tenure, in other words, turns an HSA into something closer to a savings account.

The database also shows a divergence. More than 40% of the accounts in EBRI's database were opened between 2022 and 2024. Yet enrollment in high-deductible health plans, the only plans that pair with HSAs, fell among private-sector workers with employee-only coverage from 57.9% in 2022 to 51.9% in 2024, according to the Medical Expenditure Panel Survey's Insurance Component. Accounts are multiplying faster than the plans that supply them. That leaves a large, young cohort at the low end of the tenure curve.

For plan sponsors and their advisers, the practical question is whether the 2024 cohort matures into the kind of accountholders who invest. Nothing in the report guarantees it. The HSA's tax advantages — deductible contributions, tax-free growth, tax-free withdrawals for qualified expenses — only deliver if money stays in the account. The levers are familiar: contribution design, an investment menu beyond cash, and education aimed at short-tenure participants.

The record balance shows that money can accumulate. The 18% investment rate shows that plan design has not yet turned accumulation into long-term savings. Every year an accountholder stays in cash is a year the tax advantage goes unused. The next EBRI report will show whether the record cohort starts investing like older accountholders or keeps paying out like the 56%. Most accountholders have not had time yet.