InComm Benefits HSA User Survey Reveals Account Underutilization Drives Higher Than Expected Out-of-Pocket Costs

Accountholders say automated features and cash back incentives may solve frustrations with ability to spend funds on eligible health and wellness expenses

ATLANTA, Sept. 24, 2025 /PRNewswire/ -- In a national survey of Health Savings Account (HSA) users conducted by InComm Benefits*, a division of global payments technology provider InComm Payments, a majority of accountholders want to use their HSA as a spending tool to cover eligible health and wellness expenses. Despite that desire, half of accountholders admit they do not submit reimbursements for out-of-pocket spend on eligible expenses because "the process is a hassle." This underutilization leads to more lost value than accountholders realize.

"These results show a disconnect between the promise of HSAs and how employees actually experience them," said David Etling, SVP and GM at InComm Benefits. "While most account holders see their HSA as a spending tool for everyday care, many are running into barriers that stop them from using their funds. That trend leaves money behind for both employees using the HSA and their employer who contributes to it."

The survey of 1,227 current HSA users revealed that:

• HSA users say most of their funds are meant for spending, not investing. In fact, respondents indicated that, on average, 75% of their HSA funds are earmarked for current and future healthcare expenses like prescriptions, vision needs and urgent care.
• The HSA spending experience is frustrating. A significant share of users (54%) said they have tried to use their HSA-connected card on eligible retail items and been declined at checkout. Additionally, 64% of accountholders admit they avoid using their HSA when they are not confident on the eligibility of an expense. In some cases, this frustration may even lead to delayed treatment, as 40% of HSA users say they have put off medical care because they couldn't afford it.
• Users are leaving more money on the table than they realize. Nearly all respondents (93%) estimated they spend less than $2,000 out of pocket per year on HSA eligible expenses. However, an analysis of their actual reported expenses and the frequency of non-reimbursement revealed the average to be about $4,500 per year. In other words, accountholders underestimate the value they lose from underutilizing their HSA.

The InComm Benefits survey also asked HSA users about tools and features that would address these challenges and enable accountholders to get their desired value from their accounts. Respondent answers were nearly unanimous.

• Automatic purchase-sorting would drive down frustration. Nearly all (97%) of respondents said they'd be more likely to use their HSA at checkout if eligible expenses were automatically recognized and sorted, relieving them of receipt hoarding and reimbursement guesswork.
• Cashback incentives also moved the needle. 61% of respondents said cashback rewards are one of the features they most want to encourage frequent use of their HSA.

"Employees are trying to do the right thing. They're setting aside money and budgeting for care, but many of the tools aren't keeping up," said Etling. "A single frustrating experience at checkout can discourage people from using the benefit at all. If we want HSAs to deliver on their promise, we have to make them easier to trust and use."

To learn more insights about HSA user behavior, visit www.InComm.com/Benefits/2025-hsa-employee-research/.

*InComm is a financial technology company, not a bank. Banking services for HSA, FSA and HRA accounts are provided by Coastal Community Bank, Member FDIC. 

About InComm Benefits
InComm Benefits is the future of employee benefits with automated and intuitive spending accounts, including HSA, FSA, Dependent Care, Lifestyle and more. Simplify the user experience by providing automatic purchase recognition and receipt tracking. Employees can more easily take advantage of triple-tax savings using one card. Employers benefit from higher adoption rates, boosted employee satisfaction and savings using cutting-edge solutions. Learn more at www.InComm.com/Benefits.

About InComm Payments
InComm Payments is an innovative global payments technology provider. Leveraging dynamic technology and proven expertise, InComm Payments delivers enhanced end-to-end payment platforms and emerging financial technology solutions through a single integration, helping businesses grow across a wide range of industries including retail, healthcare, tolling & transit, incentives, mobile payments, digital currencies and financial services. By enabling omnichannel connections and alternative payment options to an ever-expanding consumer base in an increasingly digital ecosystem, InComm Payments creates seamless and valuable commerce experiences across the globe. With three decades of experience, over 525,000 points of retail and online distribution, 412 global patents and a presence in more than 40 countries, InComm Payments leads the payments industry from its headquarters in Atlanta, Ga. Learn more at www.InCommPayments.com.

‍Media Contacts
Anthony Popiel 
Communications Manager 
InComm Payments 
[email protected] 

Brandon Davis
Communications Manager
InComm Payments
[email protected] 

SOURCE InComm Payments