Top HSA Spend Merchants Reflect a New Era of Consumer-Driven Healthcare
Top HSA Spend Merchants Reflect a New Era of Consumer-Driven Healthcare
New Lively data shows that merchants from Amazon, Lilly, and Warby Parker to GLP-1s, digital therapy, women’s health, and health tech, HSAs are fueling everyday health decisions
SAN FRANCISCO--(BUSINESS WIRE)--Lively, Inc., a top-rated health and lifestyle benefits platform* and #1 fastest growing HSA provider according to Devenir1, known for building the modern Health Savings Account (HSA), today reveals our 8th Annual HSA Spend Report. The report reveals that the merchants where consumers spend their HSA dollars are changing — and those changes are redefining how healthcare is accessed, paid for, and experienced.
Top HSA Spend Merchants Reflect a New Era of Consumer-Driven Healthcare; New Lively data shows that merchants from Amazon, Lilly, and Warby Parker to GLP-1s, digital therapy, women’s health, and health tech, HSAs are fueling everyday health decisions
Share
Based on anonymized 2025 HSA debit card transaction data, Lively identified a growing mix of retail brands, digital health platforms, and direct-to-consumer healthcare companies among top HSA spend merchants. Together, they signal a clear shift toward healthcare that is more consumer-driven, digital-first, and integrated into everyday life.
“The merchants people choose tell us how healthcare is evolving,” said Alex Cyriac, co-founder and CEO of Lively. “HSAs are no longer reserved for hospitals and doctors’ offices — they’re being used across a broad ecosystem of consumer health brands.”
What Top HSA Merchants Reveal About Consumer Health Spending
Retail healthcare is becoming mainstream
Large retail and e-commerce platforms, including Amazon and LillyDirect (Eli Lilly’s direct-to-consumer pharmacy platform), rank among the top merchants by HSA debit card transaction volume. Amazon HSA spend increased 123% year over year, while LillyDirect surged 5,610% year over year, reflecting growing consumer adoption of direct-to-consumer pharmacy channels for prescription therapies. Consumers are increasingly using HSAs to purchase over-the-counter medications, medical supplies, and wellness products alongside everyday purchases.
At the same time, vision and optical brands such as Warby Parker and 1-800 Contacts appear prominently in HSA spend data, reflecting how consumers are embracing simplified, direct access to routine healthcare needs like eye exams, glasses, and contact lenses.
Digital therapy and mental health platforms are seeing increased engagement
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.
These platforms reflect a broader trend toward:
- On-demand access to care
- Reduced stigma around mental health
- Healthcare experiences that fit into daily schedules rather than clinical settings
The presence of these merchants among top spend categories highlights mental health as an increasingly routine — and normalized — component of healthcare spending.
Direct-to-consumer health brands are expanding beyond prescriptions
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
- Ongoing care relationships rather than one-time visits
Their growing presence reflects consumer demand for healthcare that feels more like a service and less like a system.
Newcomers and health tech point to preventive and proactive care
Lively’s report also shows early signals of HSA spend flowing to new health and wellness platforms, including Function Health, as well as health technology companies like Oura Ring.
These merchants suggest consumers are increasingly using HSAs for:
- Preventive health insights
- Long-term wellness tracking
- Data-driven approaches to personal health
This represents a shift toward proactive care — spending on health before illness occurs.
Hospitals still drive large costs — but not everyday engagement
Hospitals and health systems continue to account for the largest share of total HSA dollars spent, reflecting the high cost of acute and complex care. However, these transactions occur far less frequently than spend at retail, digital, and direct-to-consumer health merchants.
The contrast highlights a growing divide with HSAs as the financial layer of consumer health:
- Hospitals dominate high-cost events
- Consumer health brands dominate day-to-day healthcare spending
Taken together, these merchant trends show HSAs evolving into active healthcare wallets — tools consumers use to manage healthcare continuously, not just during major medical events.
“Healthcare spending is becoming more personal, more digital, and more frequent,” added Shobin Uralil, co-founder and COO of Lively. “HSAs are increasingly the financial layer connecting consumers to the health brands and services they rely on most.”
The full report, 2026 HSA Spend Report, is available now from Lively.
About Lively
Lively is the health and lifestyle benefits provider that gets it right. Our solutions are designed to take the guesswork out of managing benefits and drive efficiency for HR teams. Our innovative platform combines robust features with unparalleled service, to make maximizing your benefits as simple as it should be.
Lively currently offers HSA, FSA, HRA, COBRA, Direct Bill, Commuter, Lifestyle Spending Accounts, and Medical Travel Accounts.
*Lively’s HSA is top-rated according to Morningstar’s 2024 Health Savings Account Landscape, G2, Trustpilot, and Lively's Customer Satisfaction survey.
1Devenir Research “2024 Year-End HSA Market Report” and “2025 Midyear HSA Market Report.” Based on percentage growth in total HSA assets and total HSA accounts among the top 10 custodians listed by Devenir over the measured period. Rankings reflect Devenir-reported data only. Lively did not pay for participation in, nor commission, these reports.
