These are made-up example plans, not recommendations. Numbers are illustrations of how the math works for one assumed situation. Your plans, prices, doctors and health will differ. A single employee with an ongoing condition, regular specialist visits, labs and prescriptions; the PPO example also charges about $600 a year in copays.
Assumptions
| 2027 plan year | HSA plan | PPO |
|---|---|---|
| Self-only coverage, you pay / month | $160 | $220 |
| Deductible | $3,000 | $750 |
| Coinsurance after deductible | 20% | 20% |
| Out-of-pocket maximum | $7,500 | $3,000 |
| Copays (annual, flat) | $0 | $600 |
| Employer HSA deposit | $500 | $0 |
| You put in the HSA | $1,500 | $0 |
| Tax rate used | 22% federal + 7.65% FICA |
Total yearly cost at three levels of care
| Year of care | Medical spending | HSA plan, net / yr | PPO, net / yr | Lower cost |
|---|---|---|---|---|
| Stable year (visits, labs, prescriptions) | $6,000 | $4,575 | $5,040 | HSA plan by about $465 |
| Flare-up year (infusions, specialist) | $14,000 | $6,175 | $5,640 | PPO by about $535 |
| Hospital stay year | $30,000 | $8,475 | $5,640 | PPO by about $2,835 |
Net cost = premiums + your share of care (deductible, then coinsurance, up to the out-of-pocket maximum, plus copays) − employer HSA money − tax savings on your HSA deposit. Worst case (both maximums reached): HSA plan $8,475 vs PPO $5,640. The two plans cost the same at about $11,324 of care; the HSA plan is cheaper below that. Unspent HSA money stays yours and is not counted above.
Open this example in the HSA vs PPO calculator and change any number to match your own plans.
What matters in this situation
- You are likely to reach the deductible early, so the plan comparison collapses to premiums + out-of-pocket maximum − employer HSA money − tax savings.
- Check that your drugs and specialists are covered and what tier your drugs are on, because a drug that is not covered does not count toward the maximum.
- Some HSA-eligible plans cover certain chronic-condition drugs and services before the deductible under IRS guidance (Notice 2019-45 and later updates); check the plan documents.
- The HSA still gives you tax-free savings that roll over, which is why people with ongoing costs sometimes keep the HSA plan; the totals above leave that out.
If a manufacturer coupon or copay card is involved, ask whether the amount counts toward your deductible and out-of-pocket maximum; plans differ.
Also see all HSA vs PPO situations, the four basic examples, how health plan costs work and 2027 HSA limits.
This is general information, not tax or insurance advice. Confirm details with your plan documents, the IRS and a qualified professional.
General education, not insurance, tax or legal advice. Figures from IRS and HHS publications; confirm with your plan documents.