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 couple expecting a baby, enrolling in family coverage for the plan year of the birth.
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 | $5,500 |
| 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 |
|---|---|---|---|---|
| Uncomplicated delivery year | $12,000 | $9,310 | $9,600 | HSA plan by about $290 |
| Delivery with complications | $25,000 | $11,910 | $11,500 | PPO by about $410 |
| NICU stay or high-risk pregnancy | $45,000 | $11,910 | $11,500 | PPO by about $410 |
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 $11,500. The two plans cost the same at about $22,947 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
- A planned birth makes this a near-certain high-cost year, so compare the worst-case totals ($11,910 vs $11,500), not just the low-use case.
- The spending levels above are illustrative round numbers for total allowed charges (prenatal care, delivery, newborn care), not national averages; real bills vary widely by hospital and plan.
- Adding a newborn to your plan is usually a special enrollment event with a short window (often 30 days for job plans, 60 for the marketplace), so check the deadline with HR.
- HSA contributions are limited month by month: moving from self-only to family coverage when the baby arrives changes your limit; see the last-month rule.
- Maternity and newborn care are essential health benefits under the ACA, and on in-network care the out-of-pocket maximum caps your share once you reach it. Out-of-network bills may not count toward it.
If you expect the pregnancy to cross two plan years, each year has its own deductible and maximum, so timing of services can change the totals.
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.