How many Health Spending Accounts and Flex Spending Accounts Exist in the United States?
The estimated number of Health Spending Accounts (HSAs) and Flex Spending Accounts (FSAs) in the US is around 21 million and 29 million respectively. Although we found no research study that was explicitly based on all payers, the surveys were based on the majority of the market so should be broadly in line with the total number of accounts across all players. Below are details of the surveys and reports from which these estimates are extracted.
NUMBER OF HSAS
According to Devenir, a company which provides investment solutions for HSAs, there were “over 22 million accounts at the end of 2017”. This figure was based on a survey conducted over the months of January and February 2018. Note that information was primarily collected from the “top 100 HSA providers in the health savings account market”, and therefore was not an exhaustive survey of all payers. However, as the figure is based on data from the biggest HSA market players, we can assume that the majority of the market is covered and the total number of HSAs across all payers is unlikely to be significantly higher. The Devenir report also noted that the estimated asset total across these accounts was $45.2 billion.
The number of accounts estimated by Devenir is fairly consistent with the figure for HSA enrollment that AHIP (America’s Health Insurance Plans) reported for one year earlier, as of January 2017. AHIP found that there were around 21.8 million individuals (or 21,824,627) enrolled in HSAs. Again, this data was not exhaustive as it was based on information from only 52 health insurance providers. Also, it should be noted that AHIP reports the number of HSA enrollees and not the number of HSAs themselves, which are different. As dependent family members may be enrolled onto a single HSA, the number of HSA enrollees may be higher, however, as “individuals and families can have more than one account” it is likely that these differences offset each other, hence why the figures from Devenir and AHIP are similar.
Other companies and organizations report similar estimates for total number of HSAs. The company FSA Store, which bills itself as a “one-stop-shops stocked exclusively with FSA and HSA eligible products and services” claims there are 20 million HSAs. And the Aite Group reported 18.6 million HSAs in 2016, and an estimated 21.4 million HSAs in 2017 using "analysis...based on Q4 2016 Aite Group interviews with 34 account benefit executives".
Estimates for the total number of HSAs range from 20 million to over 22 million, therefore we can conservatively take an average estimate of around 21 million HSAs. This number could increase markedly "as it has been estimated that 7.3 million HSA-eligible health plan enrollees had not opened an HSA", according to an Employee Benefit Research Institute article published in July 2017.
NUMBER OF FSAS
We located only one source that provides an estimate of the number of FSAs, which was the study from the Aite Group. Their research determined there were 27.4 million FSAs in 2016, and an estimated 28.8 million FSAs in 2017.
The number of enrollees on FSAs is higher than the number of FSAs, as spouses and dependents can be enrolled onto an employee’s FSA. The company FSA Store indicates that around 35 million individuals “are covered by a Flexible Spending Accounts”. This is in line with a figure reported by Reuters in 2014 of approximately 33 million individuals enrolled on FSAs. Although this article is slightly outdated, it has been included as relevant to support the current number of enrollees.
Although there was limited information available online regarding the number of HSAs and FSAs, based on available reports we can determine that there are currently around 21 million HSAs and 29 million FSAs in the US. We also found that enrollees in HSAs and FSAs are around 22 million and 35 million respectively.