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 family of four with routine pediatric care, some sick visits and an occasional ER trip.
Assumptions
| 2027 plan year | HSA plan | PPO |
|---|---|---|
| Family coverage, you pay / month | $400 | $500 |
| Deductible | $5,000 | $1,500 |
| Coinsurance after deductible | 20% | 20% |
| Out-of-pocket maximum | $9,000 | $5,000 |
| Copays (annual, flat) | $0 | $0 |
| Employer HSA deposit | $1,000 | $0 |
| You put in the HSA | $3,000 | $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 |
|---|---|---|---|---|
| Light year (checkups, a few sick visits) | $3,000 | $5,910 | $7,800 | HSA plan by about $1,890 |
| Typical year (ER trip, a few prescriptions) | $9,000 | $8,710 | $9,000 | HSA plan by about $290 |
| Heavy year (broken bone, specialist, imaging) | $22,000 | $11,310 | $11,000 | PPO by about $310 |
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 $11,910 vs PPO $11,000. The two plans cost the same at about $20,447 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
- Family plans can have a deductible per person (embedded) or per family; see embedded vs non-embedded. The example uses one family deductible for simplicity.
- The gap between the two out-of-pocket maximums ($4,000) is the most you could lose by choosing the HSA plan in a bad year.
- Kids’ preventive care (well visits and many vaccines) is covered before the deductible on both kinds of plans.
- The family HSA limit is $9,000; employer money counts toward it.
A family with a regular specialist, therapy or ongoing prescriptions may hit the maximum every year, which usually favors the plan with the lower maximum.
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.