Dental Patients Are Sitting on $174 Billion in HSA Funds — What to Do About It

There is a funding source available in a significant number of your patient consultations that most dental practices never ask about.

It isn’t a new financing product. It isn’t a government program. It’s a Health Savings Account that has been quietly accumulating in your patient’s name, often for years, while their dental treatment sat unscheduled. And the scale of what’s sitting unclaimed is staggering.

By year-end 2025, Health Savings Account assets reached nearly $174 billion across 41.7 million accounts nationwide, a 19% year-over-year increase that shows no sign of slowing.¹ The practices that learn to bring this conversation into the treatment coordinator’s workflow will close cases that practices without this knowledge continue to lose.

What the Numbers Actually Mean for Your Practice

The $174 billion figure is attention-grabbing, but the details behind it are what make it actionable for dental treatment planning.

At year-end 2025, 4.1 million HSA accounts held balances of at least $10,000, and 1.7 million accounts held more than $25,000.¹ Those aren’t outliers.

They represent a meaningful share of the HSA-holding population, and they map directly onto the patient demographic most likely to be sitting in a large case consultation.

A patient carrying $25,000 in HSA funds could potentially fund a significant portion of a full mouth reconstruction or a dual arch All-on-4 procedure without a single dollar of financing.

The average HSA balance rose to $5,457 in 2025, up 11% from the prior year, as account holders increasingly treated their HSA as a financial buffer against rising healthcare costs rather than a simple reimbursement tool.²

That average, applied in a payment stacking conversation alongside insurance, a cash deposit, and FSA funds, meaningfully reduces the financing gap on large cases and brings the monthly payment into a range more patients can say yes to.

The Patients Most Likely to Have Meaningful Balances

Not every HSA account holder is carrying a balance worth discussing in a treatment consultation. But the segment that is carrying significant balances is larger than most dental teams assume.

Roughly 10% of HSA accounts hold invested assets, meaning the account holder has moved beyond simple cash contributions into long-term investment growth. That 10% holds 59% of all HSA assets when deposits and investments are combined.¹

An account holder in that group carries an average combined balance of $22,635, compared to $2,469 for cash-only accounts.¹ These are patients who have been deliberate about building their HSA as a financial asset, which means they’re also patients who are most likely to respond positively to a well-informed conversation about deploying those funds for treatment.

Employer-affiliated HSAs account for 61% of all accounts and 65% of total assets, which reinforces the profile of the patient most likely to have a meaningful balance.¹

They’re employed, benefits-enrolled, and in many cases receiving employer contributions that have been compounding alongside their own. They are sitting in dental chairs across the country, and in most cases no one has ever asked them what their HSA balance looks like.

How to Ask Without It Feeling Like a Financial Interrogation

The HSA conversation fails when it’s introduced abruptly or framed as a data-gathering exercise. It succeeds when it’s positioned as the practice doing its homework on the patient’s behalf.

The most effective treatment coordinators weave the HSA question into a broader funding discovery conversation that happens before the treatment total is ever presented. Something like: “As we put together a payment plan that works for your situation, do you happen to have a Health Savings Account?

Many patients are surprised by how much it can reduce the monthly payment on a case like this.” That framing is curious, not transactional. It signals competence rather than commission.

Practices that use a structured payment planning tool to guide this conversation find that the HSA question lands differently when the patient can immediately see what their balance does to the financing gap. The question stops feeling like an inquiry and starts feeling like a solution being assembled in real time.

The Open Enrollment Opportunity Most Practices Miss

For patients whose HSA balance isn’t large enough to move the needle on a large case today, the consultation itself can plant a seed that closes the case in the future. HSA contribution rates have been rising steadily, with employees increasing their own contributions as healthcare costs climb.²

The patients approaching their employer’s open enrollment window are making decisions right now about how much to put into their HSA for the coming year.

A patient who walks out of a consultation understanding that a higher HSA election would directly reduce their monthly payment on a treatment plan they want has a concrete, personal reason to maximize that election.

That’s not a sales conversation. That’s genuinely useful financial guidance that positions your practice as a trusted partner, not just a provider.

With the One Big Beautiful Bill Act enacted in 2025 expected to expand HSA eligibility to millions of additional Americans in 2026, the population of patients carrying HSA funds is growing.² The open enrollment conversation becomes more valuable every year.

What Changes When Your Treatment Coordinator Knows How to Use HSA

The difference between a treatment coordinator who knows about HSA and one who knows how to use it in a consultation is the difference between a talking point and a closed case.

Knowing about HSA means mentioning it. Using it means entering the patient’s balance into a live payment calculator, watching the financing gap shrink in real time, and presenting the resulting monthly payment to a patient who can now see that their HSA has been working for them all along.

That experience is what converts a patient who came in skeptical about affordability into one who leaves with a plan in hand and a decision already forming.

The Case-Closed Pro calculator includes a dedicated HSA input that calculates the balance’s impact on the financing gap immediately, alongside every other available funding source. See how it works at caseclosedpro.com/#how-it-works. The conversation your treatment coordinator has been missing is built directly into the workflow.

The Trajectory Is Only Going One Direction

The HSA market is not a trend that is peaking. Devenir projects the market will surpass $234 billion in assets across 49 million accounts by the end of 2028.¹ Every year, more patients arrive with more accumulated HSA funds and less awareness of how to deploy them for the dental treatment they need.

The practices that build HSA fluency into their standard treatment presentation now are not catching up to a trend. They are getting ahead of one.

Your patients are holding the funding. Your team just needs to know how to find it, enter it into the stack, and show the patient what it makes possible.

References

1. Devenir. HSA Assets Reach Nearly $174 Billion at Year-End 2025 as Investment Assets Rise to $85 Billion. April 2026. devenir.com
2. Morningstar. 2025 Health Savings Account Landscape. 2025. morningstar.com
3. SHRM. HSA Balances Rose in 2025. 2025. shrm.org

Case-Closed Pro is a dental treatment financing calculator built for treatment coordinators who present large, high-value cases. It combines up to twelve payment methods into a single patient-facing payment plan, built live in the consult room in minutes. Try it free at caseclosedpro.com.