Expanding HSA eligibility could pay for GLP-1s

• Key Insight: Discover how expanded HSA eligibility could shift GLP‑1 costs into consumer-funded care.
• What's at Stake: Employers' benefit budgets and access decisions face pressure from rising GLP‑1 costs.
• Supporting Data: About $150 billion sits in roughly 50 million HSA accounts nationwide.
• Source: Bullets generated by AI with editorial review

As employers face growing pressure to cover costly GLP-1s for weight loss, an expansion of health savings accounts (HSAs) may be the best hope to satisfy massive consumer demand for this emerging drug category. It's also an opportunity to empower health plan members to shoulder financial responsibility in making this lifestyle choice, which squares with healthcare consumerism messaging over the past 25 years. 

Starting in 2026, the One Big Beautiful Bill Act expands HSA eligibility by making more bronze and catastrophic ACA plans HSA-qualified, increasing the eligible population by roughly seven million. It marks the first regulatory expansion of the HSA space in 20 years.

Joe Markland, co-founder and president of Enrichly HR, predicts that there will be a movement from silver plans to more affordable but higher-deductible bronze and catastrophic plans. 

"I think making these plans HSA-eligible is a little bit of a throw-in reaction to what is anticipated to be many consumers increasing their exposure with higher deductible plans," he says, noting that it's what the federal government wants all consumers to do moving forward. "There will be a push to get as many people on HSAs as possible to start funding more routine expenses — those less than, say $2,000 — through an HSA vs. insuring them. This will make the smaller expenses more of a cash economy vs. insured markets."

Read more: 3 free HSA tools to use during and beyond open enrollment

HSAs are a logical source of financing GLP-1s considering that last year alone $42 billion was spent on healthcare products and services, according to Scott Cutler, president and CEO of HealthEquity, the nation's largest HSA and consumer-directed benefits administrator. He also points out that $150 billion of assets are sitting in 50 million HSA accounts nationwide.

It comes at a time when employers are devoting considerable time and thought to developing a GLP-1 strategy, one of the fastest-growing contributors to healthcare cost increases. They're also trying to effectively manage their health employee health benefits spend. GLP-1s represent upwards of 7% of total drug costs, he notes, with the average American spending $2,400 a year on prescriptions. "This is potentially 20% of overall prescription costs," Cutler adds.

HealthEquity recently began offering a curated platform connecting its members with affordable GLP-1 weight-management medications and a direct HSA enrollment platform. 

The new offering, provided in partnership with licensed telehealth provider Agile Telehealth, enables members to access GLP-1 physician consultations, prescription management and ongoing care with seamless HSA payment processing. 

Read more: How Trump's GLP-1 agreements will impact benefit costs

Noting that these accounts are portable, he views the triple-tax-advantaged HSAs as a strategic opportunity to help provide affordable healthcare options to health plan members by helping them save 30% to 40% on a pretax basis. 

"We've had this program available for only about a month, but we're seeing a really nice encouraging uptake from our members that have enrolled," Cutler reports.

With healthcare cost increases growing three times that of wages, employers face an affordability crisis with regard to providing health benefits for their employee populations. At the same time, he also notes that more consumers are willing to spend money on programs outside of insurance coverage that they find attractive for their overall wellness.

Still, there's a need for much better education about the power of HSAs. Cutler says it's interesting that only 4% of account holders contribute the maximum allowed in terms of an annual contribution, which is about $8,500 a year compared to about $24,000 for a 401(k) plan. Moreover, only 10% of those with HSAs are considered investors. The Center on Budget and Policy Priorities also notes that working Americans who earn less than $50,000 a year account for just 4% of HSA contributions. 

"We know that those who use HSA dollars actually contribute more," he says. "So, engagement in this product is really important to drive greater adoption and usage of these types of funds."

In a recent LinkedIn post, he added: "The more we empower people to own their health dollars, the closer we get to what every family deserves: healthcare that is affordable, understandable and under their control."