Canadians use health savings accounts more often for retail, virtual care, and preventive tech than big hospital bills
Retailers like Amazon and drug makers such as Eli Lilly are rapidly climbing HSA rankings, even as hospitals still account for the biggest individual health bills, according to Lively’s 2026 HSA Spend Report.
Lively, Inc., which describes itself as a top‑rated health and lifestyle benefits platform and the #1 fastest‑growing HSA provider according to Devenir, released its 8th Annual HSA Spend Report using anonymised 2024–25 HSA debit card transactions.
The company analysed where HSA dollars are flowing, how merchant mix is changing and what this means for employers, brokers and benefits leaders.
According to Lively, the average Lively HSA balance reached US$5,457 in 2025, up 11 percent from US$4,923 in 2024 and the highest average since the firm began tracking the metric.
The report says Lively account balances were 37 percent higher than the industry average of US$3,997 reported by Devenir.
Lively characterises HSAs as “dual‑behaviour” accounts in 2025.
Members used them to fund routine healthcare, manage ongoing treatments such as GLP‑1 medications and invest in preventive health, while still building balances.
The average HSA debit card transaction in 2025 was US$124, flat from 2024.
Lively reports that hospital systems and traditional pharmacies drove most HSA spend by dollars in 2024.
In 2025, hospitals and health systems still generated the largest total HSA dollars but represented a smaller share of overall transactions than retail and digital merchants.
Across 2021–25, medical spending remained the largest category, followed by dental, vision and “other”.
For 2025, Lively breaks down consumer HSA spending as: doctor visits 46 percent, hospital 16 percent, prescription drugs 14 percent, dental 14 percent, vision and eyewear 3 percent, chiropractor 3 percent, lab work 1 percent and other 3 percent.
The report notes that the “other” category, which includes newer technologies and providers with non‑traditional merchant codes, is small but growing.
Hospitals were the top category with 16 percent of total spend in 2025, with that share flat year over year.
The report says retail healthcare “is now mainstream”.
Amazon continues to rank among the top merchants by HSA transaction, with Amazon HSA spend up 123 percent year over year.
Lively notes that, while merchant codes classify Amazon as general retail, HSA usage patterns indicate regular purchasing of over‑the‑counter medicines, medical supplies and wellness‑related products.
Large retail and e‑commerce channels sit alongside health manufacturers in HSA data.
HSA spend tied to GLP‑1 manufacturers and platforms climbed sharply in 2025: spend at Lilly increased 5,610 percent year over year, and spend at Hims & Hers increased 134 percent.
The report links this to consumers accessing GLP‑1s through direct‑to‑consumer health platforms, manufacturer‑connected programmes, digital‑first prescribing and subscription‑based care.
Lively also highlights vision and optical brands such as Warby Parker and 1‑800 Contacts as prominent merchants, and notes that platforms including LillyDirect, Eli Lilly’s direct‑to‑consumer pharmacy, are among top destinations for prescription therapies.
Digital mental health services are gaining traction.
Lively reports growing transaction frequency at platforms such as Headway, BetterHelp and therapy‑focused apps like Ivy, with Headway spend up 130 percent year over year.
The company links this to reduced stigma, normalised ongoing therapy, virtual access and more frequent smaller recurring payments.
Women’s health‑focused brands, including Ro Health and related platforms, show higher HSA engagement in 2025.
According to Lively, this reflects spend on reproductive and hormonal health, fertility support and ongoing condition management.
The report also identifies early but rising HSA use for preventive health and technology.
Newer platforms such as Function Health and wearable brands like Oura Ring appear more frequently in transactions, signalling spend on proactive health monitoring, data‑driven wellness and consumer‑managed health insights.
Lively says employees expect flexibility in where they spend healthcare dollars and view digital‑first options as mainstream.
The report adds that mental health and women’s health need structured benefits strategies and that retail healthcare purchasing is accelerating.
Lively points to the need for clear eligibility guidance, merchant transparency and support for small, frequent transactions that match real‑world behaviour.
Lively co‑founder and COO Shobin Uralil said “healthcare spending is becoming more personal, more digital, and more frequent,” and cast HSAs as “the financial layer” that connects consumers with the health brands and services they use most.
