One-Third of Americans Say They Can’t Afford to Contribute to an HSA

Harvard Business Review’s article sponsored by Centivo, Does Your Health Plan Leave Your Workers Functionally Uninsured?, can be boiled down to this one statement: “Unfortunately, one-third of Americans say they can’t afford to contribute to an HSA.” This assertion is made referencing Centivo’s December 2021 Healthcare and Financial report.

Centivo surveyed 805 adults 18-64 years of age who had employer-based private health insurance continuously for the past two years. Their objective was to gain a better understanding of the financial and health-related issues and sacrifices people must make due to unexpected medical expenses. A finding of Centivo’s research is that workers face mounting healthcare affordability issues, and health plan cost sharing features such as high deductibles are an underlying cause.

This is not so much an “affordability issue” but a behavioral economics challenge – inertia, anchoring, framing effects, availability heuristics and loss aversion.

  • The minimum deductible for a Health Savings Account (HSA) capable plan is $1,400. Average employer contribution to the HSA was $575 single, $987 family.
  • Eighty-five percent of covered workers in 2021 are enrolled in a plan with a general annual deductible for single coverage, similar to the percentages last year (83%) and five years ago (83%) but higher than the percentage ten years ago (74%).
  • Covered workers in a plan with a general annual deductible, the average annual deductible for single coverage is $1,669, similar to the average deductible ($1,644) last year.
  • For covered workers in plans with a general annual deductible, the average deductibles for single coverage are $1,271 in HMOs, $1,245 in PPOs, $1,852 in POS plans, and $2,424 in HDHP/SOs.
  • The average annual worker contributions to premiums for workers in HSA-qualified HDHPs are $1,134 for single coverage versus $1,204 (HMO), $1,389 (PPO), and $1,299 (all plans – including HSAs-capable plans).

The challenge is one of implementation; getting workers to focus on the differences in contributions, deductibles, employer support in the form of contributions to HSAs and out of pocket expense maximums. The implementation challenge often arises when a plan sponsor/employer simply introduces an HSA-capable coverage as an alternative to a traditional PPO and/or HMO option, without any education or transitions. (


To succeed at prompting workers to leverage the tax preferences only available through a Health Savings Account, a plan sponsor should deploy many of the same processes widely used in 401k plans:

  • Reduce the health coverage offering to a single HSA-capable option (for comparison, you only get one 401k plan at your current employer), and, where individuals enroll in health coverage,
  • Default individuals into enrollment and contributing to the Health Savings Account, and
  • Provide transition rules/features/protections for individuals when they first enroll in HSA-capable coverage.