# HDHP vs PPO calculator

Source: https://www.getprescience.com/tools/hdhp-vs-ppo-calculator
Author: Rishab Jain, Cofounder and CEO, Prescience
Published: 2026-10-28
Updated: 2026-10-28
Cite as: Rishab Jain. "HDHP vs PPO calculator." Prescience, October 28, 2026. https://www.getprescience.com/tools/hdhp-vs-ppo-calculator

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

## Compare your two plans

_Interactive calculator: open the page in a browser to use it. The rules and figures it applies follow._

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.

## 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

**A typical year, $3,000 in medical bills**

Illustrative. PPO: $200 a month, $1,000 deductible, 20% coinsurance, $5,000 out-of-pocket max. HDHP: $90 a month, $3,000 deductible, 20%, $7,000 max, with a $1,000 employer HSA contribution. The employee puts in $1,000 of their own at 22% federal and 5% state tax.

- PPO premiums + care: $2,400 + $1,400 = $3,800
- HDHP premiums + care: $1,080 + $3,000 = $4,080
- Less employer HSA and tax saved: $1,000 + $346.50
- HDHP net cost: $2,733.50

**The HDHP costs $1,066.50 less.** The premium savings and HSA money more than cover the higher deductible.

**A bad year, $20,000 in medical bills**

Illustrative. The same two plans after a surgery.

- PPO: $2,400 + $4,800 = $7,200
- HDHP before HSA help: $1,080 + $6,400 = $7,480
- HDHP net cost: $6,133.50

**The HDHP still costs $1,066.50 less,** but it needs $6,400 in cash during the year, which is harder if your HSA balance is small.

## Who should pick an HDHP, and who shouldn't

**HDHP or PPO at a glance**

|  | 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](https://www.getprescience.com/guides/hdhp-vs-copay-plan) covers the trade-off in more detail, and the [HSA contribution calculator](https://www.getprescience.com/tools/hsa-contribution-calculator) shows each employee's limit after your contribution.

**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.

[Compare plans for my employees](https://www.getprescience.com/quote)

[Review the employer plan decision](https://www.getprescience.com/guides/hdhp-vs-copay-plan)

## 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.

**One family member with a $5,000 bill**

Illustrative. A PPO with a $1,500 individual and $3,000 family embedded deductible, and an HDHP with a $5,000 aggregate family deductible; both at 20% coinsurance.

- PPO: $1,500 + 20% × $3,500 = $2,200
- HDHP: $5,000 (all deductible)

**The HDHP costs $2,800 more for this bill** before premiums and HSA money. If one person in your family uses most of the care, run the family numbers carefully.

## 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.

> **Prescience Diamond: A company health plan with an effective $0 deductible.** With an effective $0 deductible, Diamond takes the worst-case line in this calculator out of most employees' year.
> - **An effective $0 deductible** and simple copays shown before a visit
> - **A broad national PPO network,** plus providers we contract with directly
> - **24/7 physician-led care navigation** that books visits and explains costs
> - **Usually 10–20% below comparable fully insured coverage,** fixed in your quote, with no admin fees
> Best for teams of about 15 or more that want one great group plan. [Get a Diamond quote](https://www.getprescience.com/get-started?p=Employer&product=diamond)

## Frequently asked questions

**Is an HDHP cheaper than a PPO?**

In premiums, almost always. Over a whole year, it depends on how much care you use, how much your employer puts in the HSA and your tax bracket. For many healthy people the HDHP costs less in total.

**What counts as an HDHP in 2026?**

A plan with a deductible of at least $1,700 for self-only or $3,400 for family coverage, and an out-of-pocket maximum no higher than $8,500 or $17,000. In 2027 the figures are $1,750 / $3,500 and $8,700 / $17,400.

**How much does an HSA save in taxes?**

Contributions through payroll skip federal income tax, FICA (7.65%) and most state income taxes. At a 22% federal bracket and 5% state tax, that's about 34.65 cents on every dollar.

**What if I can't afford the HDHP deductible?**

Then the PPO may be the safer choice even if the HDHP looks cheaper on paper. Medical bills arrive before your HSA has built up, and providers expect payment.

**Can I have an HSA with a PPO?**

Only if the PPO itself qualifies as an HDHP. A standard PPO with a low deductible and copays doesn't, so you can't contribute to an HSA while enrolled in it.

**Does the calculator include copays?**

No. It models the deductible, coinsurance and out-of-pocket maximum. Copays usually make a PPO slightly more expensive in low-use years than shown.

## Sources

- [IRS Revenue Procedure 2025-19 (2026 HSA and HDHP limits)](https://www.irs.gov/pub/irs-drop/rp-25-19.pdf)
- [IRS Revenue Procedure 2026-24 (2027 HSA and HDHP limits)](https://www.irs.gov/pub/irs-drop/rp-26-24.pdf)
- [IRS Publication 969, Health Savings Accounts and Other Tax-Favored Health Plans](https://www.irs.gov/publications/p969)
- [HealthCare.gov, plan and network types](https://www.healthcare.gov/choose-a-plan/plan-types/)
- [KFF, 2025 Employer Health Benefits Survey](https://www.kff.org/health-costs/2025-employer-health-benefits-survey/)