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Marketers are having a tougher time selling high-deductible health plans together with health accounts, and they're having a tougher time getting workers to focus on the health account offers.
The percentage of U.S. adults with a combination of HDHP coverage and a health savings account or health reimbursement arrangement fell to 15% in 2025, according to new survey data from the Employee Benefit Research Institute and Greenwald Research.
That was down from 18% in 2024, and that was down from the level of 18% to 19% that EBRI and Greenwald reported for every year from 2020 through 2023.
The people who took the survey had a tougher time answering the question: The percentage who could not remember whether they had been offered HRAs or HSAs increased to 14%, from 11%.
The percentage of participants who said they were extremely, very or somewhat familiar with "consumer-directed health care" or "consumer-driven health care plans" fell to 67%, from 76%.
The survey: EBRI and Greenwald based the data on results from an online survey conducted in late 2025. The sample included 2,001 people ages 21 through 64.
About 81% of the survey participants had employer-sponsored health coverage.
The questions about HDHPs and health accounts were part of a survey questionnaire that was designed to measure consumer engagement in health care and health coverage decisions.
What it means: Employers and benefits advisors are talking a lot about employee engagement systems and programs, but the systems and programs may not be working very well.
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