Hospitals still drive the largest HSA dollars

A new report from the health and lifestyles benefits platform Lively Inc. identifies an increasing mix of retail brands, digital health platforms and direct-to-consumer healthcare companies among the top HSA spend merchants. Collectively, Lively officials say, they signal a shift toward healthcare that is more consumer-driven, digital-first and integrated into everyday life.

“The merchants people choose tell us how health care is evolving,” says Alex Cyriac, Lively co-founder and CEO. “HSAs are no longer reserved for hospitals and doctors’ offices; they’re being used across a broad ecosystem of consumer health spending.”

Lively’s eighth annual HSA Spend Report is based on anonymized 2025 HSA debit card transaction data and reveals that large retail and e-commerce platforms, including Amazon and Lilly, rank among the top merchants by HSA debit card transaction volume. Consumers are increasingly using HSAs to purchase over-the-counter medications, medical supplies and wellness products alongside everyday purchases.

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At the same time, vision and optical brands such as Warby Parker and 1-800 Contacts appear prominently in HSA spend data, too, reflecting how consumers are embracing simplified and direct access to routine healthcare needs such as eye exams, glasses and contact lenses. HSA spend is also flowing to digital mental health and therapy platforms, including networks and services such as Headway, BetterHelp and therapy-focused apps like Ivy.

According to Lively, these platforms reflect a broader trend toward on-demand access to care, reduced stigma around mental health and healthcare experiences that fit into daily schedules rather than clinical settings.

Additionally, consumer health companies like Hims & Hers and Ro are emerging as notable destinations for HSA spend, particularly in areas such as men’s health, women’s health and chronic condition management. These brands emphasize transparent pricing, digital-first access and ongoing care relationships rather than one-time visits. Their growing presence reflects consumer demand for health care that feels more like a service and less like a system, according to Lively.

Other key findings from the report:

• Retail and digital-first health merchants increased their share of HSA spend year over year.
• Amazon remains one of the top merchants by transaction volume.
• Health technology and preventive care platforms, including Oura Ring and Function Health, are emerging in HSA transactions.
• Hospitals and health systems continue to drive the largest dollar totals but represent a smaller share of total transaction count.

“Healthcare spending is becoming more personal, more digital, and more frequent,” says Shobin Uralil, Lively’s co-founder and COO. “HSAs are increasingly the financial layer connecting consumers to the health brands and services they rely on most.”

This article was originally published on BenefitsPRO, a sister site of HR Executive. For more content like this delivered to your inbox, sign up for BenefitsPRO newsletters here.

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