Lively Releases 2021 Data Showing COVID-19 Continues to Impact Routine Healthcare Spending

Despite vaccine rollouts, lifted mask mandates, and a growing mental health crisis, health spending remained largely stagnant.

Lively 2021 HSA Spend Report (Graphic: Business Wire)

SAN FRANCISCO--()--Lively, Inc., creators of the modern Health Savings Account (HSA), today released its fourth annual HSA Spend Report, giving a view into how and where consumers spend on healthcare costs each year. Findings show that despite hopes that COVID-19 would be a thing of the past in 2021, the pandemic and unusual healthcare spending associated with it have persisted for another year. Even with widespread vaccine rollouts, booster approvals, lifted mask mandates, and return to work plans in place, 2021, unfortunately, looked a lot like 2020.

Overall, in 2021 there was very little percentage change in HSA spending across the majority of categories from last year. Most notably, there was no increase in spending on mental healthcare, despite the United States’ growing mental health crisis. Even with more remote options and an emphasis on mental health from many employers and the media, account holder’s mental healthcare spending remained at about 3% of 2021 HSA spend, similar to 2020 and 2019.

Other Key Findings of the 2021 HSA Spend Report Show:

  • 2021 Healthcare Spending Mirrored 2020: Much like mental healthcare, doctor visits and services saw a 0% change from 2020. There was slight growth in hospital (+2%) and vision and eyewear (+3%).
  • Making Routine Visits a Routine Again: HSA account holders took care of the routine and specialized treatments they put off during the beginning of the pandemic, and dental care saw a 13% increase to account for 16.4% of HSA spending. Dental spending in 2021 is higher than pre-pandemic levels – in 2019, it accounted for 16% of HSA account holder spending.
  • National Pharmacies Dominate Prescription Spending, but Amazon Continues to Gain Market Share: Prescription drug spending fell by 7%, from 13.2% to 12.23% of overall HSA spending. Overall, larger national pharmacies dominate the market and capture the largest market share, with Walgreens leading the way – followed by CVS and Rite Aid. However, Amazon continues to cannibalize pharmacies’ market share – growing 13% since 2020, accounting for 4.97% of all prescription drug spending.
  • HSAs Continue to be Used for Regular and Expected Yearly Medical Expenses: When expected medical, dental, and vision expenses are combined, in 2021, 68% of all HSA spending is used for expected yearly medical costs -- that percentage jumps to 80% when accounting for prescription drug spending.

“With remaining uncertainty about how COVID-19 will continue to affect our day-to-day lives, Americans need to know all of their healthcare spending options and how they can use them,” said Shobin Uralil, COO and Co-founder of Lively. “It is essential to increase awareness and education around HSAs. That way, if the unthinkable happens, again, Americans will be able to access the services necessary to help them get back on their feet.”


Lively collected anonymous data from a randomly selected subset of account holders (75,000) who had an HSA account in 2021. This includes accounts with active contributions and ones without. To classify the types of health goods or services that were provided, HSA debit card spend data from January to December 2021 was categorized by merchant category codes (MCCs). No demographic or personal information was provided or used to create these cohorts. As such, any demographic details are based on post-data collection analysis.

About Lively

Lively is the modern benefits experience built for—and by—those seeking stability in the ever-shifting healthcare landscape. By harnessing modern innovation and deep industry expertise, Lively is committed to bridging today's savings with tomorrow's unknowns. Unlike traditional institutions hindered by bureaucracy, Lively's commitment extends beyond initial set up to providing dedicated, ongoing support and education for every step. We help each account reach its maximum potential with minimal headache. Lively is headquartered in San Francisco, CA with additional offices in Boise, ID. For more information, please visit or follow us on Twitter (@LivelyHSA).


Jennifer Parson


Jennifer Parson