Lively HSA spending and

national health trends

How HSA spending has changed year-over-year.

How Lively account holders use their HSAs tends to reflect the overall state of healthcare spending.

After some fluctuations during the height of the pandemic and just after, when Americans put off hospital and dental visits, HSA spending has stabilized over the past two years. This reflects a return to “normal” at least in terms of health-related spending, and that HSAs are more fully integrated into account holder’s spending and saving habits.

HSA overview spending year-over-year

Overall, HSAs can be split into three categories of account capabilities: savings, investments, and spending. Understanding this spending can help brokers and employers see how these accounts are actually being used. By analyzing the codes of debit card transactions that took place in 2023, we can see major trends in HSA spending.

Category
2019
2020
2021
2022
2023
Medical
81%
81.9%
80%
80.2%
81%
Dental
16%
14.5%
16.4%
15.5%
15%
Vision
3%
3%
3.1%
3.3%
3.2%
Other
N/A
0.6%
0.7%
N/A
N/A
%

of debit card swipes are at pharmacies, including big box stores, for over-the-counter items.

+%

Spending on prescription drugs increased 17% in 2023.

-%

Spending on mental health, already the smallest percentage of HSA spending, declined by 20% in 2023.

HSA consumer spending habits

Category details
2019
2020
2021
2022
2023
% change
Doctor visits
50%
48.7%
48.5%
47%
46%
-2%
Dental
16%
14.5%
16.4%
15.5%
15%
-4%
Hospital
15%
13.6%
13.8%
14.7%
15%
2%
Prescription drugs
10%
13.2%
12.2%
13%
15%
17%
Vision and eyewear
3%
3%
3.1%
3.3%
3.2%
-3%
Chiropractor
2.5%
3%
2.8%
2.9%
2.8%
-2%
Lab work
2%
1.7%
1.5%
1.3%
1.2%
-12%
Other
1%
1.6%
1.4%
1.6%
1.5%
-8%
Mental health
0.3%
0.3%
0.26%
0.2%
0.15%
-20%

Understanding spending habits and trends

%

was the average increase in the price of prescription drugs in 2023.

The majority of HSA spending is on routine doctor visits and preventative care, similar to the past several years. There are several important trends to note:

Over 50% of all HSA debit card swipes are at pharmacies, including grocery stores, and average debit card spend has fallen over the past few years. Increased over-the-counter spending could be driving down the average cost per translation, as account holders use their HSA debit cards for daily health and wellness-related purchases. In 2020, under the CARES act the IRS expanded the list of eligible expenses to include menstrual care products and over-the-counter products and medications to be reimbursable without a prescription. As such, this could cause the average price per transaction to fall.

Spending on prescription drugs increased by 17%. This could be due to the increase in price overall of prescription drugs. According to a survey by the US Department of Health and Human Services, over 4,200 prescription drugs had a price increase in 2023 and the average drug price increase was 15.2%.

Spending on mental health continued to decline. Despite increased focus by employers and public relations campaigns on the importance of mental health, mental health already accounts for the smallest percentage of HSA spend. It accounts for just .15% of HSA spending last year, which was down 20% from 2022. This could be because services like teletherapy and wellness programs are outside of HSA spend, or because there’s a lack of account holder education around what mental health services are covered by their Health Savings Account.

After fluctuating during the height of the COVID-19 pandemic in 2020 and 2021, spending levels on doctor’s visits and hospitals have remained fairly steady, with some slight fluctuation, in 2022 and 2023. This could indicate a return to “normal,” with doctor's offices and elective surgeries able to happen more regularly than they could during the height of the pandemic in 2020 and 2021.

$

average HSA debit card transaction, down slightly from $125 in 2022, compared to the industry average of $132, an 18% increase from $112 in 2022.

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