This Jan. 9, 2013 photo shows the Silver Cross Emergency Care Center in Homer Glen, Ill. (AP Photo/M. Spencer Green)

A (big) change is gonna come — in health account trends.

New research from the Employee Benefits Research Institute foreshadows a big shift in health accounts, with health reimbursement accounts declining and health savings accounts thriving.

EBRI found that HSAs, which can be funded by employer and employee contributions, continue to expand, while employer-funded HRAs declined in 2013 for the first time in a decade.

According to the EBRI report, there were 4.7 million HRA accounts in 2013, down from 5.1 million in 2012, while the number of individuals with HSAs increased from 6.6 million to 7.2 million between 2012 and 2013. Assets in HRAs fell slightly and were about $5.8 billion in 2013, while assets in HSAs increased from $11.3 billion to $16.6 billion between 2012 and 2013.

“Both HSAs and HRAs have been around long enough now that a growing percentage of the population has held them for a number of years. Together, they covered about 26 million people in 2013, representing about 15 percent of the privately insured market,” said Paul Fronstin, report author and director of EBRI’s health research and education program. “But two types of plans appear to be taking different directions.”

In 2013, the average account balance in an HSA was $2,311, as compared with $1,236 in HRAs. Average HSA balances increased from just above $1,400 in 2008 to $2,311 in 2013. In contrast, average HRA balances increased from $1,130 in 2008 to $1,236 in 2013. 

The report, which analyzed HSA and HRA assets, account balances and rollovers, also found:

  • Total Asset levels growing: In 2013, there was a combined total of $23.8 billion in HSAs and HRAs, spread across 11.8 million accounts. The total number of accounts was up slightly from 2012, when there were 11.7 million accounts. Total assets were up from about $18 billion in 2012.
  • After leveling off, average account balances increased: The combined average HRA and HSA account balance increased to $2,010 in 2013. 
  • Rollovers increasing: As the accounts age, the number of individuals with a rollover increased until 2013, and the total level of assets being rolled over has increased in all years except for 2010 and 2013. By 2013, 7.9 million individuals rolled over $9.2 billion.