Health Savings Accounts through a Gender Lens

Nevenka Vrdoljak is a Managing Director for the Chief Investment Office at Merrill and Bank of America Private Bank, and Susan Feng is a Vice President for Global Risk Management at Bank of America. Opinions are the authors’ own, as of the date of the report and subject to change.

A Health Savings Account (HSA) is a resource that many employees can use to save and pay for their immediate as well as longer term healthcare expenses. Since the HSA model was first introduced in 2003, HSAs have grown to hold $104 billion in assets and include 35.5 million accounts (year-end 2022), for a 24% annual growth rate over the past 16 years.[1]

This is an important development, since a recent Society of Actuaries study found that 61% of pre-retirees were concerned about having enough money to pay for healthcare in retirement.[2] Other estimates show that a 65-year-old couple retiring today will need an average of $296,000 to cover out-of-pocket healthcare costs in retirement.[3]

Projected Healthcare Costs Differ for Men and Women

A recent study administered by the Bank of America examined differences between men and women holding 565,791 Health Savings Accounts (HSA) as of 2022. Based on the analysis, it is estimated that a healthy woman’s lifetime healthcare insurance premiums will cost nearly $200,000 more than those of a healthy man.[4] The size of this gap heightens the need for women to plan carefully if they are to cover their present and future medical expenses. This is even more imperative given the fact that women live longer than men, on average. In fact, the Social Security Administration notes that, at age 65, women can expect to live an average of 21.8 more years, while men an average of 19.1 more years.

The Basics of a Health Savings Account

An HSA is a potentially tax-advantaged personal savings account that can help those with a high-deductible health plan (HDHP) contribute money that can be used to pay for out-of-pocket medical expenses such as doctor visits, vision and dental care, and prescriptions. The Bank of America report had shown that a hypothetical 45-year-old couple maximizing its HSA contributions to age 65 could cover medical expenses in retirement worth potentially $281,975, or 95%, of retiree healthcare expenses. The couple would also have $57,730 in savings from tax deductions because of the HSA contributions over that period. This example assumes an initial contribution of $7,750 that grows at 2.8% p.a., a $1,000 catchup contribution from age 55 to age 65, annual withdrawals of $2,000 that grow at 4.0% p.a., an effective tax rate of 25%, and the HSA account balance grows at 5%. It also assumes health care expenses in retirement of $296,000. Account fees are not included.

Key Findings

  • HSA utilization rates are comparable by gender.Of the 565,791 HSA participants in the 2022 study, women’s utilization rates were slightly (lower) (85%) than men’s (89%).
  • Women’s dollar HSA contributions are lower than for men. The median annual HSA dollar contribution in 2022 was $1,100 for women versus $1,300 for men.
  • Very few participants (are) maximize their HSA contributions. The percentage of participants making the maximum contribution was below 10% for both women and men. [The maximum individual contribution limit in 2022 was $3,650 annually, and $7,300 in a family plan. Employer contributions, if offered, count toward these limits. Persons age 55+ may contribute an additional $1,000 p.a..]
  • Yet there are differences across age cohorts. A higher percentage of Millennials and Gen Xers contributed to HSAs than did Baby Boomers, though a larger percentage of Baby Boomers and Gen Xers were contributing at the maximum limit.
  • Women’s HSA cash and investment balances lag those of men.For participants with investment balances (96,184), women’s median HSA investment balances stood at $6,900 versus $7,900 for men. For participants with cash balances (531,843), women’s median HSA cash balance stood at $970 versus $1,000 for men The percentages of women and men with a cash balance were the same (94%); however, only 13% of women maintained an investment balance compared to 19% of men.
  • Women are more likely than men to take HSA distributions earlier in life, while men save the HSA assets longer.Women tend to withdraw more from their accounts, sooner, whereas men save more and actively invest those funds more. The median HSA net dollar saving (contributions less withdrawals) is only $1 for women versus $47 for men.

Tips to Help Women and Men Bolster Their Retirement Preparedness

  • Consider funding an HSA as early as possible
  • Maximize HSA contributions
  • Look into using the HSA as a saving and investing vehicle
  • Don’t plan to rely solely on Medicare to cover retiree medical costs

[1] 2022 Year-End Devenir Health Savings Account Research Report, 2023.

[2] Society of Actuaries Research Institute., 2021 Retirement Risk Survey Brief Report: Identifying Retirement Risks and Trends, October 2022.

[3] EBRI “Projected Savings Medicare Beneficiaries Need for Health Expenses Spike in 2021”, January 20, 2022. Note: These costs include deductibles, copays and premiums for Medicare Part A, Part B and Part D, as well as Medigap insurance costs. They do not include services not covered by Medicare, such as over-the-counter medications and most dental services.

[4] HealthView Services, “Addressing the Women’s Longevity Gap,” September 2020.


Views of our Guest Bloggers are theirs alone, and not of the Pension Research Council, the Wharton School, or the University of Pennsylvania.


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