Insurance
HDHP vs PPO Calculator
A low premium and a high deductible trade certainty for cost. The high-deductible plan wins in a healthy year and in a catastrophic one where both plans hit their cap; the PPO wins in the messy middle. Where that middle sits is what this calculates.
Tested against worked examplesHow we verify
The full billed cost of your care this year, before insurance.
Your share of costs after the deductible is met.
Free money that only comes with the HDHP.
Your contribution × marginal rate. Only the HDHP allows one.
The HDHP costs less by: $4,475
The HDHP costs less by
$4,475
Premiums plus your share of care, net of employer HSA money and the tax break.
One plan is cheaper at every level of spending here, including a worst-case year. That usually means the premium gap outweighs everything the other plan can save you — worth double-checking the figures on your benefits summary.
- HDHP — net cost for the year
- $1,800
- PPO — net cost for the year
- $6,275
- HDHP — premiums
- $1,800
- PPO — premiums
- $5,400
- HDHP — you pay toward care
- $2,000
- PPO — you pay toward care
- $875
Cost breakdown for the year
| Line | HDHP | PPO |
|---|---|---|
| Annual premium | $1,800 | $5,400 |
| Deductible you pay | $2,000 | $750 |
| Coinsurance you pay | $0 | $125 |
| Total out of pocket | $2,000 | $875 |
| Employer HSA + tax break | -$2,000 | $0 |
| Net cost | $1,800 | $6,275 |
Compare scenariosTry three values of one input
| Expected medical spending | |||
|---|---|---|---|
| The HDHP costs less by | $4,700 | $4,475−$225 | $4,250−$450 |
| HDHP — net cost for the year | $1,550 | $1,800+$250 | $2,050+$500 |
| PPO — net cost for the year | $6,250 | $6,275+$25 | $6,300+$50 |
| HDHP — you pay toward care | $1,750 | $2,000+$250 | $2,250+$500 |
| PPO — you pay toward care | $850 | $875+$25 | $900+$50 |
Every other input stays at the value you set above — currently $2,000 for expected medical spending. Differences are measured against the first column.
Saved scenariosSave this calculation
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How this calculator works
For each plan, spending is applied to the deductible first, then coinsurance takes its share of the remainder, and the total is capped at the out-of-pocket maximum. Twelve months of premium is added, and employer HSA money plus your tax saving is subtracted from the HDHP. The crossover is found by scanning spending levels in $100 steps until the ranking reverses.
Copay-first plan designs, separate prescription deductibles, out-of-network costs and family versus individual deductible structures are not modelled — real plans differ in ways that no single calculation captures. Use this to narrow the choice, then verify against the Summary of Benefits and Coverage for each plan.
What this assumes
- Premiums, deductible, copays and out-of-pocket maximum as entered, with the expected usage you specify.
- In-network care only. Out-of-network costs frequently do not count toward the same maximum and can be unlimited.
- It cannot model the year you have an unexpected serious illness, which is the year insurance exists for.
What changes this number
- Expected usage
- Decides the comparison. A low-usage year favours a high-deductible plan; one hospital admission reverses it.
- The out-of-pocket maximum
- The number that matters in a bad year, and the one people compare least.
- HSA eligibility
- A qualifying high-deductible plan unlocks the only triple-tax-advantaged account available, which is worth real money beyond the premium.
A worked example
Take the a healthy year scenario. These figures are produced by the calculator above, not written alongside it, so they always match what the tool returns.
What you enter
- Expected medical spending
- $500
What it returns
- The HDHP costs less by
- $5,600
- HDHP — net cost for the year
- $300
- PPO — net cost for the year
- $5,900
- HDHP — premiums
- $1,800
- PPO — premiums
- $5,400
One plan is cheaper at every level of spending here, including a worst-case year. That usually means the premium gap outweighs everything the other plan can save you — worth double-checking the figures on your benefits summary.
Try an example
Frequently asked questions
Is an HDHP or a PPO cheaper?
The HDHP wins in a healthy year, when the premium saving is nearly the whole story, and often in a catastrophic year, when both plans hit their out-of-pocket maximum and the lower premium still counts. The PPO wins in between — a few thousand dollars of care, enough to blow through a high deductible but not to reach the cap.
Does the HSA change the answer?
Substantially. Only an HDHP allows one, and the tax break plus any employer seed money often exceeds $2,000 a year. That amount is a straight deduction from the HDHP's cost, and it is the single most common reason the comparison lands where people do not expect.
What is coinsurance?
Your percentage share of costs after the deductible, until you reach the out-of-pocket maximum. A plan with a $3,000 deductible and 20% coinsurance means you pay the first $3,000, then a fifth of everything after that, until the cap stops the bleeding.
How do I estimate next year's medical spending?
Start with last year's total billed cost, from your insurer's claims summary rather than what you paid. Add anything known — a planned surgery, a pregnancy, an ongoing prescription. Then run this calculator twice: once at that figure, once at a bad year. A plan that is fine in both is the safer choice.
What does this calculator not cover?
Network differences, prescription tiers, separate drug deductibles, out-of-network coverage, referral requirements, and per-visit copays that apply before the deductible. All of them can matter more than the arithmetic here, and all of them live in the plan documents.
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Disclaimer: DayCents provides this calculator for educational purposes only. Results are estimates based on your inputs and the stated assumptions — they are not financial advice, a quote, or an offer of credit. Consult a qualified financial professional before making major money decisions.