On February 23, 2026, the Congressional Research Service (CRS) released a report on trends in HSA usage. The report presented key findings on HSA utilization, enrollment, and contributions based on recent data and surveys.
HSAs were established as a tax-advantaged financial instrument that allows individuals to accumulate and utilize funds for unreimbursed medical expenses, such as deductibles, copayments, coinsurance, and services not covered by insurance. Eligibility for HSA contributions is contingent upon enrollment in a high-deductible health plan (HDHP); however, an HSA functions as a trust or custodial account rather than as health insurance.
Individuals who are eligible can contribute or receive contributions to an HSA. Account holders have the option to invest these funds and make withdrawals for qualified medical expenses not reimbursed by insurance. HSAs confer several tax benefits: individual contributions are tax deductible unless made via a cafeteria plan; both employer contributions and employee contributions made through a cafeteria plan are exempt from taxable income as well as Social Security, Medicare, and unemployment insurance taxes; investment earnings within the HSA are tax-exempt; and withdrawals are not subject to taxation if used for qualified medical expenses.
CRS combed through data provided by the IRS to find insights into how HSAs are administered and used. Highlights include:
- HSA-Qualified HDHP Enrollment: Enrollment in HSA-qualified HDHPs grew steadily from the mid-2000s through 2020, with survey data showing increases in both the number and percentage of people covered. While growth plateaued between 2020 and 2024, there were indications of renewed increases in 2025. Larger employers were more likely than smaller ones to offer HSA-qualified HDHPs and had higher employee enrollment rates.
- HSA Access Among Workers: In 2025, 41% of workers had access to an HSA through their employer, with access more common in larger firms and higher-paying occupations. Service workers had the lowest access rates. Historically, access increased from 2014 to 2020, stabilized, and then rose again in 2024 and 2025.
- HSA Contribution Data: For tax year 2021, there were 2 million tax returns reported as individual HSA contributions and 12.1 million reported as employer contributions. Employer contributions were common among those aged 26 to 64, peaking among those aged 35 to 54. Individual contributions were less frequent but slightly increased with age. Both types of contributions were most prevalent among higher-income filers.
- Age and Income Trends: HSA participation was lower for those under 26 and those 65 and older, likely due to eligibility restrictions (e.g., dependency status, Medicare enrollment). Employer contributions grew steadily from 2017 to 2021 for ages 26 to 64, while individual contributions remained flat. Higher adjusted gross income (AGI) was associated with a greater likelihood of both employer and individual contributions.
- HSA Withdrawal Data: The number of tax returns reporting non-rollover HSA withdrawals increased from 2004 through 2020, with a slight decline in 2021. In 2021, 8.8 million tax returns (5.5% of filed returns) reported such withdrawals, with about 4% of these being taxable. Withdrawal rates were lowest for ages 26 to 34 and highest for ages 35 to 64 and increased with higher AGI up to $1 million.
Employer Takeaway
For employers, the CRS data reinforces that HSAs remain a widely used benefit, particularly when paired with employer contributions. Larger employers continue to lead in offering HSA‑qualified HDHPs, and employees appear to be far more likely to participate when employers contribute to the account.
Employers considering an HSA‑qualified HDHP – or evaluating their current HSA strategy – may want to focus on contribution design, employee education, and communication around the long‑term value of HSAs to maximize engagement and perceived benefit.
For more information, read the CRS Health Saving Accounts Report.