How HR Can Boost HSA Participation During Open Enrollment

About one in three Americans has no emergency savings at all, according to a recent survey by Empower. That means an employee on every team is just one unexpected medical bill away from financial strain that spills into the workplace as missed hours, decreased focus, and lower engagement.

Open enrollment is HR’s best chance all year to close the gap between benefit offerings and actual employee participation. So right now, HR teams have a prime opportunity to spotlight Health Savings Account (HSA) benefits – a key tool to help employees ease financial stress and build long-term security. 

To explore how HR can successfully boost HSA participation, we turn to Dr. Stephen Neeleman, Founder and Vice Chairman of HealthEquity. With a background as a practicing surgeon and years spent helping shape consumer-directed health plans, Neeleman has focused on helping people better save, spend, and invest for health.

Health Savings Accounts and Financial Wellness

HSAs have become a foundational piece of many benefits packages because they address a critical need: helping employees manage healthcare expenses while strengthening their overall financial wellness. With more than 39 million Americans holding HSAs and assets surpassing $150 billion in 2025, these accounts are proving to be more than just a health savings tool – they’re a long-term financial strategy.

As Neeleman put it, “HSA plans, if properly designed, remain the richest benefit you can give your people.” This speaks to how HSAs combine immediate cost management with future financial security.

HR has two important roles with HSAs: first, making HSAs available as part of benefits, and second, explaining to employees how to effectively use their accounts. 

Helping employees visualize real-life scenarios is part of that effort. For example, an unexpected doctor visit can be covered with HSA funds, reducing stress over out-of-pocket expenses, while contributions left in the account can be invested to grow tax-free for retirement or future medical needs. HR’s role in breaking down these benefits into practical terms for employees builds their confidence and encourages smarter financial decisions.

Where HR Can Step In: Education and Empowerment

Many employees don’t fully understand how HSAs work, which can limit participation and reduce the benefit’s impact.

For example, if you stopped 100 people on the street who have HSAs, only a small minority would know that the money isn’t use-it-or-lose-it, or that they can invest it, Neeleman pointed out. This knowledge gap presents a clear opportunity for HR to guide employees and help them make informed choices about their healthcare spending, long-term savings and HSA participation.

One scalable solution is HSAnswers, an AI-powered education tool. “We took two decades of subject-matter expertise from our HSA Guidebook and built it into an AI tool called HSAnswers,” Neeleman explained. “It’s available for everyone to use — not just HealthEquity customers.” 

HSAnswers lets employees explore and ask questions. It helps them understand their benefits better, which may help boost HSA participation rates. For example, it addresses practical questions, such as “Can I use my HSA to pay for teeth aligners?” and “How much can I contribute to my HSA?” It also handles more sophisticated inquiries, like “I’m turning 65 at the end of the year and will be signing up for Medicare for 2026. Can I contribute to my HSA through 2025?”

HR teams can share this tool with employees during open enrollment to spark interest, provide a way to get answers and encourage confident decision-making. Once employees understand the basics of how HSAs work, HR can use technology to turn that knowledge into meaningful action.

Using HR Technology to Increase HSA Participation

Digital tools simplify account management and give HR insights to boost participation, guide smarter spending, and reduce administrative effort. For example, HealthEquity’s Assist portfolio supports this by simplifying HSA use for employees and providing HR with actionable insights to boost HSA participation and reduce administrative effort.

The Assist portfolio includes three tools:

1. Analyzer: Optimizing Plan Design

Many HR teams struggle to pinpoint why HSA adoption is flat year over year. Analyzer uncovers where plan design or contribution structures could be holding participation back, giving HR real data to adjust strategies and boost engagement before the next enrollment cycle.

By offering real-time insights into participation trends, this tool helps HR analyze their plan designs and explore ways to adjust those plans to save the company more money. For example, HSA contributions made through payroll deduction are exempt from federal income tax and also reduce employer payroll taxes such as Social Security, Medicare, FICA, and FUTA. This means both employees and employers save on taxes when contributions are made pre-tax through payroll – ultimately resulting in significant cost savings for the company.

In contrast, 401(k) contributions, while tax-deferred for employees, do not generate the same payroll tax savings for employers because payroll taxes are calculated on gross wages before the 401(k) contribution.

These tax benefits make HSAs a cost-efficient benefit that supports workforce wellbeing – and helps improve the company’s bottom line, Neeleman explained.

Employers can leverage these savings by strategically promoting HSAs to employees, providing education on their financial benefits, and aligning benefit offerings to maximize overall cost savings.

2. Navigator: Guiding Employees to Smart Care

Even when employees have HSAs, many overspend on healthcare simply because they don’t know their options. Navigator gives them a clearer view of what each choice costs before they make it. It might show, for example, that an urgent care visit for a minor injury is far cheaper than a trip to the ER.

That kind of insight helps employees make confident, informed decisions and keeps HSA funds from draining too quickly, Neeleman said. Ultimately, it promotes smarter spending and helps reduce financial stress, all while maximizing the value of HSA funds.

Importantly, when employees spend less on healthcare, it often leads to lower claims and reduced healthcare costs for the company – especially in terms of insurance premiums and employer-sponsored plan expenses.

This creates a win–win scenario, where employees benefit from better cost control and employers improve their overall healthcare cost management.

3. Momentum: Encouraging Health & Wellness

One of HR’s toughest jobs is keeping wellness programs from fizzling out after open enrollment. Momentum turns participation into a year-round habit by rewarding healthy actions with HSA dollars, linking everyday choices to tangible financial gains.

In a gamification element, employees can earn extra money for their HSAs by completing steps. As one example, Neeleman said some employers have plans that allow employees to earn HSA dollars or points that can be converted to an HSA contribution for completing specific steps, such as walking 10,000 steps per day.

Through this customizable gamification feature, this tool promotes ongoing engagement with wellness programs, connecting healthy choices to financial benefits.

Evidence shows that employees who engage in healthier behaviors and wellness programs have significantly lower healthcare costs. For example, research has found that workplace wellness programs can reduce medical costs by about $3.27 for every $1 spent on wellness initiatives. Healthier employees incur fewer healthcare claims, which translates to lower insurance premiums and cost savings for the employer over time.

Together, these three tools in the Assist portfolio streamline HSA management for HR teams and simplify benefit understanding and usage for employees.

Tackling the Biggest Barrier: Early HSA Balances

For many employees, the early months with an HSA can feel discouraging. With only a small amount saved, they may worry that the account won’t cover unexpected medical costs, leading them to avoid care or default to out‑of‑pocket payments. This low initial balance limits immediate use and may also delay consistent contributions and investing, reducing the long‑term impact of the benefit.

 One potential solution is HPay. Essentially, the Health Payment Account — or “HPay” — program is an employer-sponsored benefit that provides an interest-free healthcare line of credit to employees with the option to repay through payroll deductions.

“We’re piloting a line of credit called HPay that helps employees pay for care even if they haven’t built up their HSA balance,” Neeleman said. “HPay bridges that gap so people can get the care they need and repay later as they fund their HSA.”

Developed with Paytient, the HPay program is expected to launch for broader use in January 2026, starting with over 100 early employer partners. By providing access to care while HSA balances grow, HPay aims to remove the financial barriers that keep employees from seeking treatment.

While solutions like HPay address immediate barriers to HSA participation, broader legislative changes are also reshaping how employers can support employee access to care.

Adapting to Legislative Change

The One Big Beautiful Bill Act (OBBBA) expands access to telehealth and direct primary care, giving employees more affordable and convenient ways to get care without unnecessary costs or delays. Specifically, high-deductible health plans (HDHPs) can now cover telehealth services without affecting employees’ eligibility to contribute to HSAs. Additionally, fees for direct primary care services are considered HSA-eligible expenses starting in 2026.

To turn these changes into real benefits, HR teams should update plan materials, enrollment guides, and train benefits counselors. Clear communication helps employees understand new options and how to use them effectively, which can strengthen HSA participation.

Next Steps for HR Before Open Enrollment

Here are practical steps HR can take to educate employees and boost HSA participation.

Pre-Enrollment Prep

• Audit your HSA communication materials. Check that plan documents, FAQs, and benefits guides clearly explain contribution limits, eligibility, and investment growth potential.
• Automate employee education. Deploy tools like HealthEquity’s HSAnswers early so employees can explore HSA basics before the enrollment crunch hits.
• Train benefits counselors and managers. Make sure anyone answering questions understands recent legislative updates like OBBBA and can clarify how HSAs interact with FSAs and HDHPs.
• Highlight the employer savings angle. Include talking points on payroll tax savings to strengthen the business case internally.

During Enrollment

• Simplify decision-making. Offer quick comparisons or calculators showing how HSAs reduce out-of-pocket costs.
• Spotlight success stories. Use short employee testimonials or real examples of HSA savings to make the benefit relatable.
• Add visual aids. Use short videos or infographics to illustrate contributions, withdrawals, and tax benefits in plain terms.
• Promote participation incentives. Tie gamification or matching contributions to enrollment actions to drive immediate uptake.

Post-Enrollment Engagement

• Keep education alive. Send quarterly nudges that reinforce smart HSA use, like investment reminders or eligible-expense tips.
• Use analytics. Review participation and contribution data with tools like Analyzer to refine next year’s plan design.
• Connect health to wealth. Link Momentum-style wellness goals to HSA rewards to sustain engagement throughout the year.
• Plan for continuous feedback. Run a short survey or focus group midyear to identify what still confuses employees and adjust communications accordingly.

A proactive HSA strategy doesn’t just educate employees; it drives measurable savings across the organization.

Building a Stronger Financial Future with HSAs

Empowering employees to take control of their healthcare and savings is an important part of HR’s job to support a financially stable workforce. By providing clear education, helpful technology, and smart plan design, HR teams can boost HSA participation and help employees understand how to make the most of their accounts for both short‑term needs and long‑term financial health.

Dr. Neeleman pointed out that HR can empower employees by providing the knowledge and tools to help workers confidently manage their HSAs. Using practical innovations like AI guidance and portable, investable accounts gives employees a real opportunity to increase their HSA participation and take charge of their health and finances.