HDHP vs PPO Health Plan Calculator

Two reasons that compound. The premium gap is paid every month whether or not you use care, so it is a certain cost, while the deductible is only paid if you get sick. On top of that, HSA contributions avoid income tax and, when made through payroll, FICA as well — which makes a dollar contributed worth meaningfully more than a dollar of salary. Many employers also seed the HSA directly. Add those together and the HDHP frequently wins even in a moderately expensive year.

The total allowed amount for your care, not what you personally expect to pay. That means the negotiated price your insurer would recognize for every visit, prescription, and procedure across the year, added together. Your explanation of benefits statements from last year are the best source. Entering only your out-of-pocket costs will understate spend badly and skew the comparison toward the low-deductible plan.

No, and assuming so is a common mistake. The crossover depends on the premium difference, both deductibles, both coinsurance rates, both out-of-pocket maximums, and the value of the HSA tax break. It often lands well above either plan's deductible. The cost curves are also piecewise, with kinks where each deductible and out-of-pocket max is reached, which is why this tool sweeps the whole range rather than solving a single equation.

Yes, if you would actually contribute. The deduction is real money and ignoring it systematically biases the comparison against the HDHP. But the benefit only exists to the extent you contribute, so if cash flow means you would fund little or nothing, set the contribution to what you would realistically put in. Note also that HSA funds roll over indefinitely and remain yours after you leave the employer, unlike an FSA.

Network differences, which can matter more than any of the arithmetic here if your doctor is in one plan and not the other. Prescription tiers and drug-specific coverage. Whether services are covered before the deductible. Referral requirements. And the long-term investment value of an HSA left untouched, which for someone who can pay medical costs from cash flow is arguably the largest benefit of all and is entirely absent from this one-year comparison.