Choosing a plan is not just comparing monthly premiums. Total cost includes premiums plus what you pay when you use care.
Cost-sharing terms
The deductible is what you pay before the plan pays most costs. Copays are fixed fees for services. Coinsurance is your percentage after the deductible. The out-of-pocket maximum caps your annual spending on covered in-network care.
Plan types
HMOs require referrals and in-network care, with lower premiums. PPOs offer more flexibility with higher premiums. EPOs are in-network only without referrals. HDHPs have lower premiums and higher deductibles and unlock HSA eligibility.
Run the numbers
Estimate your expected medical use, add premiums and compare total costs in a healthy year and a bad year. Check that your doctors and medications are covered. If you are generally healthy and can fund an HSA, an HDHP often wins; if you expect lots of care, a lower-deductible plan can be cheaper.
Try the numbers
Use our HDHP vs PPO Health Plan Calculator to see this in practice. With its default example (HDHP premium / yr: $2,400; HDHP deductible: $3,500; HDHP out-of-pocket max: $6,500), it shows hdhp is cheaper by: $2,900. Adjust the inputs to match your situation.
Key takeaways
- Total cost = premiums + out-of-pocket spending.
- Check networks and prescriptions before choosing.
- Compare a typical year and a worst-case year.
This article is for general education and is not personalized financial, tax or legal advice. Rules and limits change; confirm current figures with official sources such as IRS.gov, SSA.gov and StudentAid.gov, or consult a qualified professional. © 2026 FinanzCalc.