Americans are thinking about their finances and engaging in their physical wellbeing, but they might need help to understand the connection between wealth and health, according to a recent report from HSA Bank.

HSA Bank sponsored a study which scored 2,000 randomly selected U.S. adults based on how engaged they were in their health and wealth, finding that the average American adult is “highly engaged” in thinking about both – but not necessarily holistically.

In fact, this year the researchers found some disturbing gaps in Americans’ health and personal finance knowledge – nearly one-in-five respondents don’t know what kind of health plan they have – 15% couldn’t correctly identify their plan type, and another 3% confused their carrier for their plan type.

“This seems like a low number of people who are really engaged with both their wealth and their health in a holistic manner,” said Chad Wilkins, president of HSA bank and executive vice president for Webster Bank. “As an industry, we’re not engaging on a regular or ongoing basis throughout the year helping people understand their benefits and how they relate to their finances. We need to do a better job of educating consumers.”

HSA Bank is a division of Webster Bank administering more than $7 billion in Health Savings Accounts (HSAs) and other health-related financial accounts as of December 31, 2018.

Nearly one-in-three consumers, 30%, didn’t know their premium, deductible, or out-of-pocket costs. Nearly half of the respondents, 49%, didn’t know their coverage’s copay requirements. Yet 94% of the respondents were at least somewhat confident in their ability to manage their health needs moving forward.

Wilkins said that there is a lack of resources around engaging consumers aat the time they’re making health decisions. At most employers, open enrollment for benefits takes place in early October and often lasts for only two weeks – scant time to help their employees make educated choices.

“We want to highlight that healthcare is a major part of your financial picture,” said Wilkins. “That’s why we look at it as both health and wealth.”

Americans have a high estimation of their personal health – 89% of the respondents were at least somewhat confident in their physical health and wellness.

The survey also found that many consumers are not implementing financial best practices for healthcare readiness like saving for future healthcare expenses. Two-in-5 respondents, 40%, have never saved for future healthcare expenses and another 30% have never considered the cost of their healthcare services, according to the survey.

Wilkins sees financial advisors as a perfect channel to engage with Americans on the benefits of not only saving, but using an HSA as a savings vehicle for both health expenses and retirement.

“An HSA is a huge opportunity to talk to their clients,” said Wilkins. “It offers an opportunity to potentially save them money on taxes and augment their savings for retirement at the same time. It’s a way to differentiate themselves.”

With an HSA, assets can be contributed and invested before taxes and are able to grow tax free. Assets can be withdrawn tax-free and without penalty if there is a respective qualified healthcare expense. Wilkins notes that HAS participants can fund copays and deductibles out-of-pocket and “bank” their healthcare expenses over time until retirement, then use HSA assets tax-free for other purposes.

The study’s authors concluded that Americans tend to be too reliant on their health insurance to cover their expenses.

After being asked about their health plan enrollment status, health practices, ability to pay for healthcare and confidence in their health and wealth, respondents were scored on a scale of one to 44 for healthcare engagement, and one to 56 for wealth engagement, for a maximum possible total combined score of 100. The average respondent scored a 62.3

For the second year, researchers grouped respondents into four categories by score: minimally engaged, scores zero through 39; moderately engaged, scores 40 through 59, highly engaged, scores 60 through 74, and optimally engaged, scores 75 through 100. This year’s study found more minimally, moderately and optimally engaged respondents, while the number of highly engaged respondents declined.

The study found that engagement in personal health and finance was strongly linked to the type of health insurance a respondent had.  The least engaged respondents had government sponsored or subsidized health coverage. For example, Medicaid recipients reported an average total engagement score of 54.4, and Medicare recipients reported an average total engagement score of 62.8. The most engaged respondents were those with high-deductible health plans (HDHPs), who reported an average total engagement score of 68.2.

Respondents with HSAs were not only more likely to access preventative care, they were more likely to schedule doctor’s visits than respondents with other types of health plans. The report’s authors note that conventional wisdom has held that carriers of high deductible health plans might be less likely to schedule appointments with healthcare providers because of the potentially higher out-of-pocket costs, but the survey results appear to debunk this assumption. While 71% of all respondents visited a doctor in the 12 months leading up to the survey, 81% of HSA holders had at least one doctor’s visit in the same period.

Access to an HSA also played a role in the likelihood that respondents were saving for future healthcare expenses: while 48% of the survey participants with traditional healthcare plans were saving frequently or occasionally for their future expenses, 54% of the respondents with an HSA said the same.

Age was another predictor of engagement, with millennial respondents, ages 20 to 37, reporting an average score of 59.7. Generation X respondents, ages 38 to 53, reported an average score of 62.3, while baby boomers, ages 54 to 72, reported an average score of 64.

Slight differences also existed between the genders, with women reporting slightly higher engagement in both health and wealth than men. Women were also more likely to receive preventative healthcare services and shop for health services on the basis of cost than men.

For the paper, HSA Bank commissioned a survey of more than 2,000 U.S. adults in the fall of 2018.