A new white paper published by Optum Bank and Empower Retirement provides recommendations for encouraging retirement-focused health care savings via a health savings account (HSA).

According to the firms, the underlying survey of nearly 1,000 consumers aimed to uncover the best ways to educate workers on long-term planning for health care expenses, and to understand their current attitudes and goals.

At a high level, the paper shows that even employees who have an HSA often don’t understand how it works or how their contributions can be grown by investing the funds. Furthermore, most people seem to have no idea how much health care will cost in retirement, and they are open to learning more from employers.

According to the paper, older consumers are slightly more aware than younger employees of how much money they will need for health care in retirement—possibly because they have seen firsthand how medical issues increase with age. However, the paper explains, older consumers are also less likely to have separate funds specifically segregated for health care. Regardless of age, most consumers do not have health care-specific funds at this point.

“While employees can use an HSA to pay for current out-of-pocket qualified medical expenses, a longer-term strategy of building up the balance in the HSA for health care expenses in retirement is one of the most powerful steps employees can take for retirement planning,” the white paper says. “Unfortunately, most are missing out on this opportunity.”

The survey results show nearly a third of consumers surveyed currently have an HSA, and many respondents had one previously, so, in total, almost half of respondents either currently have one or have had one in the past. But the survey results also reveal that HSA holders aren’t using the accounts strategically.

“Even among respondents who understand that HSA contributions can be invested in mutual funds or other investments (as opposed to languishing in debit checking accounts), fewer than half have considered doing so,” Empower and Optum report. “And just one-quarter of those who understand HSAs have considered using one as part of their retirement plan. That’s a small fraction considering the potential for income tax-free growth on a dedicated HSA fund that can be used income tax-free for qualified expenses in retirement.”

The white paper notes that the majority of consumers are saving or planning for retirement using multiple types of accounts, predominantly in 401(k) and traditional cash savings accounts. Of the 47% who currently have or have had an HSA, only 19% say they are using an HSA to save for retirement.

“This is the exact same percentage of respondents who said they have some money in an HSA and have invested it,” the paper explains. “These numbers suggest that people who have a balance understand that an HSA can be used as an account for retirement. But it also reveals an opportunity for education about how to maximize the benefits of an HSA, as most employees are not using one for retirement savings.”

The white paper then steps through some of the specific misconceptions that employers and advisers should tackle as they seek to explain the virtues of HSAs. One step is to make sure that individuals do not confuse health savings accounts with flexible spending accounts (FSAs), as the two are actually quite different. While FSAs are also funded with pre-tax contributions and used to pay qualified medical expenses, they cannot be rolled over toward retirement. With some exceptions, FSA funds must be spent within the calendar year or be forfeited.

“Another issue is that consumers often use their HSA funds to pay for current medical expenses, missing out on valuable compound growth potential,” the paper states. “Given the tax-advantaged benefits of an HSA, it often makes more sense to pay today’s medical bills out-of-pocket and let the HSA grow. But, here again, consumers don’t always understand the dynamics.”

The paper says this is a bit of a paradox, as people generally do seem to understand the importance of owning multiple retirement accounts.

“Consumers closest to retirement age are most likely to be saving in multiple accounts, though nearly one-third are still not doing so,” Empower and Optum report. “Younger consumers are less likely to use individual retirement accounts [IRAs], have pension plans or anticipate receiving Social Security benefits.”

When learning about retirement savings, survey respondents say they look to the internet and financial advisers. However, when learning about saving for health care expenses, they say they would go to their employer or friends and family over a financial adviser.

“These preferences make sense considering that employers have been sponsoring workplace health insurance for decades,” the paper concludes. “Just as workers expect their company to guide them on health insurance decisions, our survey shows that employees expect companies to provide education on HSAs. This dynamic presents an opportunity for employers to add more value in the health care space, where workers already count on them.”