Young Americans Lead in HSA Adoption But Carry Heaviest Economic Burden, HealthEquity Research Finds
DRAPER, Utah, Dec. 09, 2025 (GLOBE NEWSWIRE) -- As healthcare costs continue to strain American families, HealthEquity (NASDAQ:HQY), the nation's largest health savings account (HSA) custodian by number of accounts*, today released its inaugural Healthcare Affordability Pulse survey results, revealing a striking generational paradox: younger Americans are leading in HSA adoption and benefits engagement, yet they simultaneously report the highest levels of economic anxiety and workplace financial distraction.
The Fall 2025 Healthcare Affordability Pulse surveyed employed Americans and found that 56% of Gen Z and 50% of Millennials have HSAs, significantly outpacing Gen X (35%) and Boomers (24%). Despite this proactive approach to healthcare savings, Gen Z reports the highest economic concern at 84%, and younger workers are significantly more likely to say financial stress affects their workplace performance.
"We're seeing a generation that's financially engaged and taking advantage of tools like HSAs earlier in their careers, but they're also carrying a heavier burden of economic anxiety," said Scott Cutler, HealthEquity President and CEO. "Gen Z and Millennials know they need to save for healthcare and are doing their part, but they're doing it in a very different economy, one where higher costs and uncertainty are creating real stress that follows them into the workplace. Giving them simple, portable ways to save and pay for healthcare is one of the most important steps we can take to support their financial health."
Young Americans Lead in HSA Adoption and Benefits Understanding
The research reveals that younger generations are significantly more engaged with their healthcare benefits. Gen Z (53%) and Millennials (62%) report understanding their benefits "very well" or "extremely well" at much higher rates than Gen X and Boomers (both at 47%). This benefits literacy translates into action, with younger Americans more likely to have HSAs and actively use them as part of their financial planning strategy.
However, their financial preparedness tells a more complex story. Gen Z and Millennials are more likely to have less than $500 available for unexpected healthcare expenses (36% and 30%, respectively), while Boomers were significantly more likely to report having over $2,500 in their HSAs.
Economic Anxiety Impacts Younger Workers Differently
While 79% of all respondents report being concerned about the overall economy, the workplace impact varies significantly by generation. Gen X and Boomers are most likely to say finances don't impact their work performance at all (38% and 27%, respectively), while Gen Z and Millennials are significantly more likely to report that financial strain affects their ability to focus and perform well at work.
Healthcare spending priorities also differ by generation. Gen Z is most likely to cut back on mental health services (46%) and preventive care (36%) when budgets tighten, while Boomers and Gen X are more likely to not cut back on healthcare spending at all (40% and 32%, respectively).
"The fact that young people are cutting mental health services first is concerning, especially when we know they're experiencing higher levels of financial stress," Cutler noted. "This is where employer support and benefits education make the biggest difference."
HSA Holders Show Greater Financial Preparedness Across All Generations
Despite generational differences, HSA holders—regardless of age—demonstrate stronger financial readiness for healthcare expenses. Across all generations, HSA holders are more likely to feel prepared for routine healthcare expenses (52% vs. 46%), have larger emergency reserves (29% with at least $5,000 vs. 25%), and are less likely to cut back on critical healthcare services.
The research also reveals that those who understand their benefits "very well" or "extremely well" are more likely to report that their financial situation does not affect their work focus (29% vs. 20% with moderate understanding), a finding that holds true across all age groups.
Exploring Findings and Solutions
"Healthcare affordability is not a niche issue—it's a universal stressor affecting Americans across every demographic and every generation," Cutler continued. "The good news is that HSAs can help improve financial preparedness. But this research makes clear that education and employer support are critical to helping people not just save, but feel more secure—something that feels even more important given that open enrollment is still happening right now for the majority of Americans."
The HealthEquity Healthcare Affordability Pulse tracks American consumer sentiment on healthcare costs, financial preparedness, and economic wellbeing on a biannual basis. The inaugural Fall 2025 edition surveyed 618 employed Americans enrolled in employer-sponsored health plans between June 25 and July 9, 2025.
The full report, including detailed demographic breakdowns and methodology, is available for download at https://info.healthequity.com/fall-2025-healthcare-affordability-pulse.
To explore these findings alongside other emerging benefits trends, HealthEquity will host a complimentary webinar examining affordability, wellbeing, caregiver benefits, and artificial intelligence. Registration for the "Top 4 Benefits Trends to Watch for in 2026" webinar on Thursday, Dec. 11, 2025 at 12 p.m. MT is available here.
About HealthEquity
HealthEquity (NASDAQ:HQY) and its subsidiaries administer HSAs and other consumer-directed benefits for 17 million accounts in partnership with employers, benefits advisors, and health and retirement plan providers who share our mission to save and improve lives by empowering healthcare consumers. For more information, visit www.healthequity.com.
* Devenir 2025 Mid-year HSA Report
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