stylized green HSA card with bandaid The trend to invest via HSAs is increasing, although most account holders don't do so. (Photo: Shutterstock)

Health savings accounts (HSAs) have a tough reputation. Some see them as only a tax shelter for the wealthy. Others see them as being more suitable for the young and healthy.

But one thing is clear from a study by health care firm Alegeus – people who do have HSAs are becoming more engaged with how those HSAs work.

In fact, says the study, although the higher out-of-pocket costs presented by HSAs are said to discourage people from getting medical care, just 4 percent of respondents say they've avoided care to avoid the expense.

And because of their HSA,  40 percent say they've been motivated to "take a more active role in their health care." And 80 percent claim they make healthy lifestyle choices and smart health care decisions.

Just 10 percent of HSA respondents to the survey say they consider themselves unhealthy, though, and the average household income of participants is $72,400 per year.

And just 37 percent have a high school diploma or less, although 52 percent do have children.

While HSAs offer the opportunity to save and invest for future health expenses, even in retirement, participation in that vein continues to lag as most people still regard their HSA accounts as short-term savings.

The trend to invest via HSAs is increasing, but according to Devenir's 2019 Midyear HSA Research report, while more than one million accounts are investing a portion of HSA funds, that only represents a little over 4 percent of all accounts.

That means most people are still not availing themselves of the tax-free benefit of such saving and investing for medical expenses.

Even so, 54 percent do say that their account balances are growing; 38 percent say they're contributing more than they have in previous years; 28 percent say they prioritize saving for future health care expenses; and 58 percent say they may start to invest their HSA savings for growth.

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Marlene Satter

Marlene Y. Satter has worked in and written about the financial industry for decades.