Compare HDHP vs PPO on total cost — premium, deductible, max OOP, and HSA savings.
Enter two health plans and your expected medical use. The calculator computes total cost for each (premium + out-of-pocket), layers in HSA tax savings, and shows the break-even across medical-use levels.
Direct answers to the most common questions, in plain language. Skim if you're in a hurry; dig deeper below.
Compare total expected cost: premium + expected medical use.
A low-premium plan with a high deductible costs more if you use a lot of medical care. A high-premium plan with low deductible may cost more if you barely see a doctor. Compute total expected annual cost for each.
What you pay before insurance starts paying.
The amount you pay out-of-pocket before insurance kicks in. A $5,000 deductible means you pay the first $5,000 of medical costs each year before the plan covers anything (above preventive care, which is usually free).
The most you'll pay in a year.
The hard cap on what you pay in a year for covered services. Hits the cap, insurance pays 100% of further costs. ACA-compliant plans must have a max OOP of $9,200 single / $18,400 family for 2026.
HDHP for low utilizers + HSA; PPO for high utilizers.
High-Deductible Health Plan (HDHP) has lower premiums and lets you fund an HSA (triple-tax-free). PPO has higher premiums but lower deductible. If you expect light usage, HDHP wins. Heavy usage, PPO usually wins.
The mechanics in short answers — no jargon, no upsell.
You pay the premium even if you use zero medical care. Add it up: 12 × monthly premium = annual premium.
You pay 100% of covered medical costs until you hit the deductible. Preventive care is usually free, exempt from deductible.
Past the deductible, insurance covers most but not all — typically 70–90%. You pay the rest (10–30%) until you hit max OOP.
Past max OOP, insurance covers 100%. The most you'll pay in a year is premium + max OOP.
Designed so anyone can model their situation in under a minute, with or without a finance background.
Premium + expected medical use, in one number.
Side-by-side at any medical expense level.
Tax savings from an HSA-eligible HDHP factored in.
Worst-case yearly cost clearly shown.
Medical-cost level where each plan starts to win.
Quick decision tool for the once-a-year choice.
Everything you might ask before, during, or after using this tool.
Health Savings Account — a triple-tax-free account (deductible going in, tax-free growth, tax-free withdrawal for medical). Only available with HDHPs. 2026 contribution limits: $4,400 single / $8,750 family. Best account in the tax code if you have an HDHP.
Flexible Spending Account — a use-it-or-lose-it pre-tax account for medical expenses. Available with most plans (not just HDHPs). 2026 limit: $3,300. Funds expire at year-end with very limited rollover, so contribute only what you'll actually use.
PPO: any provider, higher cost. HMO: in-network only with PCP referrals required, lower cost. EPO: in-network only, no referrals needed. Choose based on your providers and how much network flexibility you need.
Open enrollment (typically October–December for employer plans; November–January for marketplace). Outside open enrollment, you need a qualifying life event (marriage, birth, job loss, move) for a 60-day special enrollment window.
Employer plan is usually cheaper if they cover a meaningful share of the premium. Marketplace can be better if employer contribution is minimal and you qualify for ACA subsidies (income under 4× FPL). Run the numbers — employer plan removes you from ACA subsidies even if you don't take it.
Providers contracted with your insurer at negotiated rates. In-network = your share is small. Out-of-network = your share is big (often 50%+) or zero coverage. Verify your specific doctors are in-network before picking a plan.
For ACA-compliant plans, yes — preventive care (annual physical, vaccines, certain screenings) is fully covered at no cost, even before deductible. Verify the specific service is on the preventive list — some are billed as diagnostic and trigger your deductible.
Federal individual mandate penalty is $0 (TCJA zeroed it). Some states (CA, MA, NJ, RI, DC) have their own penalty. Bigger issue: one major medical event without insurance can be six-figure debt. Get something, even if it's a high-deductible catastrophic plan.
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A plan with a $300/month premium and $5,000 deductible costs $3,600 + actual medical use.
A plan with a $600/month premium and $1,000 deductible costs $7,200 + actual medical use.
Below ~$3,000 of medical use, plan A wins. Above, plan B catches up. Above max OOP, plan A wins again. The break-even depends on your actual use.
If you pick an HSA-eligible HDHP and contribute the max to an HSA, you get: tax deduction now, tax-free growth, tax-free withdrawal for medical.
That stack often makes HDHP cheaper than PPO even at moderate medical usage.
Especially valuable for high earners and those who can pay medical expenses from cash flow and let the HSA compound.
The biggest hidden cost in health insurance is going out-of-network for one specialist or hospital.
A $500 in-network procedure can be $5,000 out-of-network at the same facility — same care, different billing code.
Before any non-emergency procedure, confirm in-network status of every provider involved (surgeon, anesthesiologist, hospital, lab).
Look at last year's actual medical spending — pull from your EOBs.
Pick a plan that minimizes your total expected cost: premium + likely OOP.
Factor in HSA tax savings if eligible.
Stress-test: what if a major event hits? Your max-OOP exposure should be sustainable.
Two short notes worth reading before you trust any number on this page.
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Results are not financial, legal, or tax advice. Please consult a qualified professional before any decision about your loan, investments, or personal finances. Actual loan terms and charges depend on your bank and individual circumstances.
