Many Americans would cut healthcare spending without FSAs, new data shows

• Key Insight: Learn why FSAs function as a health-spending safety net, altering consumer care decisions.
• What's at Stake: Declines in FSA access could suppress preventive care and shift provider revenue streams.
• Supporting Data: 56% of FSA users would reduce medication or treatment spending without accounts.
• Source: Bullets generated by AI with editorial review

Flexible spending accounts remain a popular tool for paying medical expenses, and many people would cut back on health spending without them. 
That was one of the key findings from new research on FSAs and health spending accounts that was presented Dec. 11 during the 2025 Financial Wellbeing Symposium by Heather Ruff, senior account executive of healthcare and employee benefits at VISA.

Ruff said that 56% of FSA users would reduce their spending on medicines and treatment if they didn't have an account. Thirty-two percent of purchases would not be made if an FSA was not available. 

Among those surveyed, most said they would cut back on over-the-counter medications, followed by vision expenses, dental visits, preventative vaccines and hospital visits. 

"All of that helps us understand the mindset of an individual who recognizes the benefit of having an FSA and what they would forego if they didn't have one in place," Ruff said.  

With HSAs, adoption remains a big issue, and many users have concerns about investing HSA funds. On average, users invest just 25% of their total HSA balance, mainly to save for medical expenses they anticipate in retirement. 

"I don't understand how that works and would be concerned about access to funds when needed," said one of the people surveyed. 

"I invest in a 401(k) plan through my employer, so I don't think using my HSA money would be wise," another said. 

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

Despite those concerns, 96% said they would like to learn more about HSAs. Websites were the No. 1 preferred source for information about HSAs, followed by employers, social media, benefits administrators and doctors. 

"All constituents really need to have a deeper understanding of their HSAs to help drive empowerment," Ruff said. 

Having an HSA continues to make users feel safe, confident and secure. "It helps discipline me to set aside money every month for my long-term healthcare," one HSA-user said in the research presented at the event.

Read more: Supporting financial wellness with HSAs and FSAs

Awareness of HSAs is strongest among those age 55 and older, while Gen Z and millennials are still struggling to understand how the accounts work, Ruff said. 

"The sooner we get them adopting and participating, the better off we are," Ruff said. "They also want to know if [HSAs] help them save money. We've talked a lot about the triple tax advantage and how that doesn't really resonate with folks anymore. We really need to make this more simplistic."

Ruff said the research on HSAs and FSAs shows the importance of emotional resonance and how making that connection can drive empowerment and adoption. 

"As we gather insights and share this knowledge, I hope it helps each of us turn up the dial a bit on how we focus on driving empowerment, education and personalization," Ruff said.