Health savings accounts ended 2025 with nearly $174 billion in total assets across 41.7 million accounts, according to year-end data from Devenir. Total assets climbed 19% year-over-year, while new account openings held steady at 6% growth.
The most striking movement came through HSA investment assets, which jumped 33% from a year earlier to approximately $85 billion by Dec. 31. The number of accounts with invested balances rose 22% to around 4.2 million, representing some 10% of all HSAs. Over the past two years, the count of investment account holders has nearly doubled.
Accounts that hold investments carried an average combined balance of $24,252, nearly 10 times the average balance of a funded account without investments. At the higher end, the number of accounts holding $10,000 or more has grown nearly sevenfold over the past decade, from roughly 599,000 at the end of 2015 to 4.1 million at the end of 2025. The $25,000-and-above tier expanded fifteenfold over the same timeframe, from 114,000 accounts to 1.7 million. In 2025 alone, that top tier added nearly 571,000 accounts.
Devenir senior vice president of research and technology Jon Robb noted that as a greater share of HSA assets moves into investments, predicting future asset levels will be less straightforward. The firm projects the HSA market will surpass 49 million accounts and $234 billion in total assets by the end of 2028, though it acknowledged that "market movement will make forward looking asset projections more difficult."
On the cash flow side, HSA holders contributed nearly $60 billion industrywide during 2025 and withdrew nearly $45 billion, retaining about $15 billion, or 25% of total contributions. Employer-sponsored payroll remained the backbone of funding, with 61% of all accounts – roughly 25 million – linked to an employer. Those accounts collectively held about $113 billion, representing 65% of total HSA assets.
Contribution behavior varied sharply by account age. Older cohorts generally spent down more than they added, while accounts opened around 2010 to 2013 were roughly at break-even. The most recently opened accounts showed the highest retention ratios: accounts from the 2023 vintage contributed 1.3 times what they withdrew, 2024 accounts contributed 1.8 times, and 2025 accounts reached a ratio of 2.8 to 1. Among funded accounts, those not tied to an employer actually carried a slightly higher average balance – $5,817 versus $5,109 for employer-affiliated accounts – even though employer-linked accounts were far less likely to be unfunded at year-end (13% unfunded, compared with 36% for non-employer accounts).
The Devenir figures arrive alongside separate research from LIMRA underscoring the financial stakes for retirees. A paper released earlier this month by the LIMRA Retirement Income Institute found that healthcare costs, long-term care needs, and caregiving responsibilities rank above market declines or recessions as the top threats Americans perceive to their long-term financial security. Chris Heye, a fellow at the institute, wrote that health-related risks are "fundamentally different from traditional retirement risks" because, unlike market disruptions, health events "often last for years, worsen over time, and create ongoing financial strain precisely when individuals have fewer options to adjust."
The LIMRA paper cited population-level health data showing that more than three-quarters of US adults live with at least one chronic illness, and that roughly 40% will receive a cancer diagnosis – most commonly around retirement age. Long-term care costs, the paper noted, can exceed $100,000 per year, largely uncovered by public programs. For advisors, these trends underscore the importance of integrating HSA strategies into broader retirement plans, especially as clients face rising health expenses. As annuity sales continue to climb, pairing guaranteed income with tax-advantaged HSA savings may offer a more comprehensive approach to retirement security.
