Enrollment in HSA and HRA plans are dropping, and a growing number of employees don’t even remember being offered one. That’s not a plan design issue. It’s a visibility issue.
Recent data shows enrollment in consumer-directed plans fell to 15% in 2025 (down from 18% from the year before), and 14% of employees couldn’t even recall whether they had access to an HSA or HRA at all. Not a great stat to hear for HR and brokers who work so hard on these plans.
It’s a missed opportunity on both sides:
- Employees lose out on tax-advantaged ways to pay for care, and real savings when they need it
- Employers lose the cost-control these plans are built to deliver, especially as healthcare expenses climb.
This is exactly where better decision support can make a difference, and why we’re continuing to invest in ALEX.
Show HSA balances at the moment of decision
One of the biggest gaps in benefits decision-making is context.
Employees are asked to evaluate plans based on premiums, deductibles, and out-of-pocket costs, but often without a clear view of the funds they already have available to offset those costs.
That’s why ALEX will now surface HSA balances directly within decision support.
- ALEX asks whether a user has an existing HSA balance they plan to use
- That balance is displayed alongside plan options and cost estimates
- Plan recommendations remain unchanged; this is about adding visibility, not steering decisions
ALEX's Impact
On average, only 21% of employees enroll in an HSA-eligible plan.
With ALEX, that jumps to 34%.
Support HRA plans that reward high-quality care
We’re also introducing support for HRA plans designed to incentivize the use of high-quality healthcare providers.
Structured like most HRA incentives, these plans can be layered on top of any medical offering. When employees choose providers within the designated incentivized network, they receive reimbursements, which encourages better care decisions and helps manage costs.
Within ALEX, employees will:
- See a clear explanation of how the HRA works
- Be prompted to enroll if eligible
- Get a direct link to sign up
- Understand the potential financial benefit based on their choices
This is another example of meeting employees where they are. Instead of expecting them to connect the dots between cost, quality, and incentives, ALEX makes those connections visible and actionable.
If you offer HSA or HRA plans, promotion can’t be passive
HSAs and HRAs are only effective if employees understand them well enough to use them and follow through by actually setting up their accounts in the program.
But as reports show, that’s just not happening. (And, it makes sense, with today’s economic uncertainty, your employees have a lot on their minds).
If enrollment is declining and awareness is spotty, the takeaway isn’t to rethink the plans; it’s to rework how they’re introduced, explained, and reinforced.
That means:
- Highlighting these options clearly during enrollment
- Reinforcing their value with real, personalized context
- Connecting them directly to financial outcomes employees care about
- Guiding them to establish their account within the specific program
This is where decision support plays a critical role. Not as a one-time explainer, but as an active part of how employees evaluate their options.
Make HSA and HRA benefits easier to evaluate
These updates to ALEX decision support are intentionally focused to:
- Surface HSA balances so employees can factor them into decisions
- Introduce and explain HRA incentives tied to high-quality care
- Reinforce the value of cost-saving benefits at the exact moment they’re being considered
They don’t change recommendations. They don’t add complexity. They make what’s already available easier to see and use.
And that’s the point.
Because in a complex benefits landscape, clarity drives action.
Turn HSA and HRA awareness into action
While we’re continuing to build toward ALEX Home, we’re just as focused on evolving ALEX decision support in ways that help right now.
That means:
- Making existing benefits—like HSA and HRA plans—more visible
- Helping employees connect plan choices to real financial outcomes
- Supporting employers in driving better utilization of the benefits they already offer
In a turbulent cost environment, incremental improvements matter.
Especially when they help more employees take advantage of the tools designed to save them money.
