The catch in saving so much in an H.S.A., of course, is the difficulty of maxing out annual contributions and leaving the money alone for four decades, paying for any needed care with other funds. Many account holders use H.S.A.s as if it were a checking account to pay for current care rather than for long-term savings. According to Devenir, an H.S.A. investment firm, 47 percent of funded H.S.A.s had withdrawals in 2023. As of mid-2024, just 9 percent of all accounts invested at least part of their balance.
H.S.A.s have been criticized by some groups as benefiting mainly more affluent Americans who can afford to invest their contributions while paying for medical costs out of pocket. The accounts were introduced more than 20 years ago, and as of mid-2024, more than $137 billion was held in about 38 million accounts, according to Devenir.