Compare your two plans
What care would cost before insurance pays. Try a few amounts.
Through payroll, so it also skips FICA.
Prefer predictable costs? Prescience Diamond has an effective $0 deductible and simple copays →
Try three spending levels: a quiet year (a few hundred dollars), a typical year for you, and a bad year. The plan that wins in all three is an easy choice. If they split, the worst-case line tells you how much risk you're taking on to save in a good year.
Copays are left out, and both plans are assumed to cover the same doctors. If your PPO uses copays for office visits and prescriptions, its real cost in a low-use year will be a little higher than shown.
A high-deductible health plan (HDHP) has lower premiums and lets you save in an HSA, but you pay more before coverage starts. A PPO costs more each month and less when you use care. Which is cheaper depends on how much care you expect, how much your employer puts in the HSA and your tax bracket. Enter both plans to see your total cost for the year and in the worst case.
- 2026 HDHP minimum deductible
- $1,700 self / $3,400 family
- 2026 HDHP out-of-pocket max
- $8,500 self / $17,000 family
- 2026 HSA limit
- $4,400 self / $8,750 family
- Tax saved on payroll HSA money
- Income tax + 7.65% FICA
How the comparison works
For each plan, the calculator adds a year of your premiums to what you'd pay for care. Care costs are your expected medical bills up to the deductible, then coinsurance on the rest, stopping at the out-of-pocket maximum. The HDHP then gets credit for two things a PPO usually doesn't have:
- Employer HSA contributions. Money your employer puts in your HSA is yours to spend on care, so it offsets the deductible dollar for dollar.
- Tax savings on your own contributions. HSA money from payroll skips federal and most state income tax and the 7.65% FICA tax. At a 22% federal bracket and 5% state tax, every $1,000 you contribute saves about $347.
The worst case uses each plan's out-of-pocket maximum. That's the most you could pay in a year for covered, in-network care.
Worked examples
Who should pick an HDHP, and who shouldn't
| HDHP with HSA | PPO | |
|---|---|---|
| Premiums | Lower | Higher |
| Cost before coverage starts | At least $1,700 self-only in 2026 | Often $500 to $2,000 |
| Tax savings | HSA: income tax and FICA | Only a health FSA, up to $3,400 |
| Unused money | Stays in your HSA, invested | Lost, apart from FSA carryover |
| Predictability | Low in the first months of a bad year | Higher, with copays |
- An HDHP usually wins for healthy people, people whose employer puts real money in the HSA, and higher earners who can afford to fund the HSA and let it grow.
- A PPO often wins for people with ongoing prescriptions or planned care that's mostly copays, and for anyone who couldn't cover the deductible in cash if something happened in January.
- It's close for families expecting moderate care. Run your own numbers instead of trusting a rule of thumb.
For employers choosing a plan lineup
Offering both is common, and it lets employees sort themselves. If you offer only an HDHP, a meaningful HSA contribution makes it fair to the people who will hit the deductible. Seeding $500 to $1,000 a year costs less than the premium difference between the plans for most groups, and the contribution is free of payroll tax.
Be careful about low-paid employees. A $3,000 deductible is a large share of a $40,000 salary, and people who delay care because of it can end up costing the plan more later. Our guide to HDHP vs copay plans covers the trade-off in more detail, and the HSA contribution calculator shows each employee's limit after your contribution.
How to estimate your medical spending
The calculator is only as good as the spending you enter. The best guide is last year: your insurer's website lists every claim with its allowed amount, which is the figure to use. Then adjust for what you know is coming.
- Regular prescriptions: the allowed price for a year's supply, not your copay. A brand-name drug at $400 a month is $4,800 of spending.
- Ongoing care: therapy, physical therapy and specialist visits at the allowed rate per visit.
- Planned events: a pregnancy and delivery, or a planned surgery, often runs well over $10,000 in allowed charges.
- A cushion for the unexpected: an urgent care visit, imaging or an ER trip can add $500 to $3,000.
Preventive care, such as annual checkups, recommended screenings and most vaccines, is free on both plans, so leave it out.
Family coverage: embedded and aggregate deductibles
Family plans handle the deductible in one of two ways, and it can change the answer.
- Embedded: each person has their own deductible inside the family one. Once one person meets theirs, coinsurance starts for them even if the family total hasn't been reached. Most PPOs work this way.
- Aggregate: the whole family deductible has to be met before coinsurance starts for anyone. Many HDHPs work this way, because an embedded deductible below the HDHP family minimum ($3,400 in 2026) isn't allowed.
Common mistakes when comparing plans
- Comparing deductibles alone. A lower deductible doesn't help if the premium difference is larger than the deductible difference and you rarely use care.
- Ignoring the employer HSA contribution. $1,000 from your employer closes most of the gap between a $1,000 and a $2,000 deductible.
- Forgetting the network. Two plans with the same numbers are not equal if your doctors are only in one of them.
- Not funding the HSA. The HDHP's tax advantage only exists if you contribute. If you won't, compare premiums and care costs alone.
Finally, revisit the choice every open enrollment. A plan that was right in a quiet year can be wrong the year you plan a surgery or start a new prescription, and premiums and employer HSA contributions change from year to year.
A third option: low cost when you use care
The whole HDHP-or-PPO question exists because most plans make you pick between low premiums and low costs at the doctor. Diamond is designed so employees don't have to make that bet: an effective $0 deductible with simple copays shown before each visit.
Choosing plans for a team? Quote the coverage you modeled
Use the same employee tiers, employer contribution and account funding assumptions when comparing proposals. Confirm the actual written benefits and HSA eligibility before relying on the calculator result.
