All the companies I've worked with that offered the high deductible plan, also would contribute a few hundred a year into your HSA…which just made it an even better deal imo.

I wish I had started our HSA years ago. The amount we have paid into the "good" plans we always went for vs what we got out of them is way tilted in the insurance companies favor. When you are young and healthy is the time to load up that HSA. I'm going to be preaching that to my daughter when she starts working.

We have a PPO and HDHP. HDHP is the clear choice in our scenario calculator especially since I've had for a long time and the HSA has grown quite large over the years

My company contributes $1500 a year into our HSA to select the HDHP. I match that. $3000 family deductible.

TXTransplant said:

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And obviously, if you don't meet your deductible, the HDHP is a no-brainer. We've only hit ours once, and at this point, I have enough in my HSA to cover that situation multiple times.

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Even if you hit thr deductible and you know it's going to happen, unless you can't budget for it yourself you're better off doing the high deductible plan.

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I do not think you are wrong. At my old company, there was at least some differences in costs between the HDHP vs the traditional PPOs where the math could work in your favor one way or the other depending on your situation.

At my current company, there is almost literally no difference other than I get to invest an extra $8,300 this year to our HSA while that option obviously doesn't exist with the PPO. I'm the only employee who opted for the HSA plan (we are a small company).

Frankly, it's kind of baffling. People are just still conditioned to take the PPO because it supposedly has better coverage when there is literally no difference in coverage between our two plans.

Example: our PPO options and HSA options have the same deductible. lol. I get to invest $8,300 extra while my co-workers can't.

jamey said:

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YouBet said:

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I do not think you are wrong. At my old company, there was at least some differences in costs between the HDHP vs the traditional PPOs where the math could work in your favor one way or the other depending on your situation.

At my current company, there is almost literally no difference other than I get to invest an extra $8,300 this year to our HSA while that option obviously doesn't exist with the PPO. I'm the only employee who opted for the HSA plan (we are a small company).

Frankly, it's kind of baffling. People are just still conditioned to take the PPO because it supposedly has better coverage when there is literally no difference in coverage between our two plans.

Example: our PPO options and HSA options have the same deductible. lol. I get to invest $8,300 extra while my co-workers can't.

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Thats exactly what I have found. I think the HSA is an inducement to get people to go that route but if people just did the math they'd see they are probably way better off not paying the high premiums. Hell, use the premium savings to pay for the HSA and invest itong term.


Personally I think the high deductible is better for us all just because we see that trip to the ER for a runny nose is expensive. It injects some sense of capitalism into healthcarem

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This is exactly why my company likes the HDHP, and our benefits people have told us that directly. My company is self-insured, and they've pointed out how expensive it is when someone goes to the ER for a non-emergency or goes to an out of network provider. Basically, this runs the premium costs up for everyone. One year they showed us the actual $ amounts.

As I said in an earlier post, I think our MOST expensive plan is actually worse coverage than the other two. Sure the deductible is the lowest (although, I'm not sure it's that much lower than the middle plan), but they've limited what practitioners you can go to. It seems to be the older "legacy" employees who seem to mistakenly think that this plan is better just because it costs more.

I also think people really like their co-pays. They want to know that, if they go to the dr, it only costs $20 (or whatever the current copay is). On our HDHP and the middle plan, there are no co-pays. If you see a dr for something other than your one annual visit/check-up, you have to pay the bill. Granted, the bill is a "discounted" rate if the provider is in network, but you don't know what the bill is going to be until you get it weeks later. I think this uncertainty is really scary to a lot of people.

HDHP+HSA normally wins especially if your company contributes. If you have a good year, you'll come out ahead. If you have a lot of expenses, you'll probably be about even compared to the PPO.

We've saved up quite a bit over the years but I do spend some of it occasionally.

I just wish you could have an HSA with all plans.

With you on the HSA - I'm hoping it's over 200k by the time I retire. It's one of my favorite investment vehicles and love watching the gains. Hopefully one year the gains will exceed the contributions for that year.

One thing I've learned on an HDHP is never pay at the office/clinic; aways ask to be billed - especially if you are receiving services over multiple visits. I think drs offices are not being as careful about billing with patients on an HDHP.

Case in point - my son had several ingrown toenails that needed to be treated. The dr would not remove more than one at a time because of the discomfort, but the treatment included the removal plus a follow up visit. On a follow up visit, my son had the initial toe checked and then had another toenail treated (this was the plan).

On one of the follow up visits, the staff tried to charge us for an initial consult. When I questioned the amount, the staff member basically said "You haven't hit your deductible, so what does it matter?"

I responded "Just send me a bill", but what I really wanted to say was "It matters because it's MY MONEY you idiot!"

I think a lot of drs offices assume we are all hitting our deductible every year and just want to get there as fast as we can. In my case, that was flat out wrong. Even with these procedures, we didn't come close to hitting the deductible, and the LAST thing I want to do is overpay or be double charged for medical services because it's usually a nightmare to get your money back.

Our plan actually has an advocacy service that will look into medical bills on our behalf. I've used it more than once to resolve a billing issue.

My rational was always go with the HSA and high deductible and max it out. If I ever get a health condition where the other plan makes more sense, I have enough in the HSA to cover my max out of pocket and I can change plans next year.

permabull said:

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My rational was always go with the HSA and high deductible and max it out. If I ever get a health condition where the other plan makes more sense, I have enough in the HSA to cover my max out of pocket and I can change plans next year.

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Thats my point though.

There is no situation where the low deductible plan makes more sense. The max out of pocket is essentially the same.

The only real difference is you
pay much higher premiums which I guess could be thought of as budgeting the cost


My wife has a health condition, wildly expensive

We have a high deductible plan. We just have to save towards the end of the year to hit the max out of pocket by March each year. Some times the drug company will pay for the widly expensive drug on our behalf. If thst happens I'm sitting on my max out of pocket of around 9k in March and just put it in a brokerage account.

I go to the doctor at most 2x per year and it's a dermatologist. I'm just never sick thankfully. I have never hit my ded ever. When I do eventually go to doc it's always inconvenient timing so I end up at minor emerg place but it's like $75/visitz….

So why commit to more money per month when I don't need services. Now I just invest in hsa

What in saying is even if you have something that costs 500K a year in medical costs

You still might as well go with a high deductible plan. There's no real difference in your max out of pocket, including the premiums with everything summed up

And at least you have access to an HSA account. And if the person kicks the bucket in December or if there a deal for an expensive drug or treatment, you may not pay the max which is ultimately the same either way. Except you're guaranteed to pay whatever premiums you sign up for

Low deductible just assures you pay more, like budgeting for something that may not happen

jamey said:

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permabull said:

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My rational was always go with the HSA and high deductible and max it out. If I ever get a health condition where the other plan makes more sense, I have enough in the HSA to cover my max out of pocket and I can change plans next year.

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Thats my point though.

There is no situation where the low deductible plan makes more sense. The max out of pocket is essentially the same.

The only real difference is you
pay much higher premiums which I guess could be thought of as budgeting the cost


My wife has a health condition, wildly expensive

We have a high deductible plan. We just have to save towards the end of the year to hit the max out of pocket by March each year. Some times the drug company will pay for the widly expensive drug on our behalf. If thst happens I'm sitting on my max out of pocket of around 9k in March and just put it in a brokerage account.

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I'll disagree on the first point that there is no situation.

I ran the numbers many, many times and childbirth absolutely is a situation where it makes sense. The HDHP came nowhere close to touching the benefits on the lower premium option when our wife gave birth to our kids.

The max out of pocket was higher, etc.

AgsMyDude said:

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jamey said:

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permabull said:

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My rational was always go with the HSA and high deductible and max it out. If I ever get a health condition where the other plan makes more sense, I have enough in the HSA to cover my max out of pocket and I can change plans next year.

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Thats my point though.

There is no situation where the low deductible plan makes more sense. The max out of pocket is essentially the same.

The only real difference is you
pay much higher premiums which I guess could be thought of as budgeting the cost


My wife has a health condition, wildly expensive

We have a high deductible plan. We just have to save towards the end of the year to hit the max out of pocket by March each year. Some times the drug company will pay for the widly expensive drug on our behalf. If thst happens I'm sitting on my max out of pocket of around 9k in March and just put it in a brokerage account.

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I'll disagree on the first point that there is no situation.

I ran the numbers many, many times and childbirth absolutely is a situation where it makes sense. The HDHP came nowhere close to touching the benefits on the lower premium option when our wife gave birth to our kids.

The max out of pocket was higher, etc.

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obviously you didnt have any NICU time.

AgsMyDude said:

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I'll disagree on the first point that there is no situation.

I ran the numbers many, many times and childbirth absolutely is a situation where it makes sense. The HDHP came nowhere close to touching the benefits on the lower premium option when our wife gave birth to our kids.

The max out of pocket was higher, etc.

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I'm really confused on this statement. I've had several kids under a HDHP and it was either the same as or cheaper than the PPO in terms of total cost out my pocket. Isn't the HDHP typically lower premiums than a PPO or other plan?

This may be company specific, but every one I've seen, the HDHP (lower premiums + max out of pocket) is roughly equal to the PPO (higher premiums + co-pays) in years where you hit the max out of pocket. In years you don't hit max out of pocket, the HSA money gets pocketed, so the HDHP comes out ahead in most years..

Whether or not the higher deductible plan can save you money on the HDHP depends entirely on how your company's premiums and deductible/OOP expenses are structured.

My company has different premiums for employee only, employee+spouse, employee+one child, and employee+family. The way the deductibles are prorated is different based on the number of people insured, too.

So, you really can't blanketly say that there is no situation where the higher premiums beat the HDHP. However, my company has done a REALLY good job of making the HDHP the "better" option for nearly all scenarios by charging much higher premiums for the alternatives and putting $1000 per family in the HSA (which they count towards the "savings").

The one exception where our lower deductible plan may beat the HDHP is if you have multiple family members on an expensive prescription medication because drug benefits are extremely limited on the HDHP.

But every plan is going to be different.

That's a big factor in the full calculation, to include the difference in premiums, all the way up to max out of pocket.


We have an expensive monthly treatment, of about 30K a month. We use the high deductible plan. Our total cost is about the same either way but we get the HSA option

TXTransplant said:

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Whether or not the higher deductible plan can save you money on the HDHP depends entirely on how your company's premiums and deductible/OOP expenses are structured.

My company has different premiums for employee only, employee+spouse, employee+one child, and employee+family. The way the deductibles are prorated is different based on the number of people insured, too.

So, you really can't blanketly say that there is no situation where the higher premiums beat the HDHP. However, my company has done a REALLY good job of making the HDHP the "better" option for nearly all scenarios by charging much higher premiums for the alternatives and putting $1000 per family in the HDHP (which they count towards the "savings").

The one exception where our lower deductible plan may beat the HDHP is if you have multiple family members on an expensive prescription medication because drug benefits are extremely limited on the HDHP.

But every plan is going to be different.

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the HDHP should be much cheaper than a PPO and paired with an HSA you keep the delta in premium.

Yes, in our case the HDHP premiums are much cheaper. My point was about whether there are some situations where the more expensive but lower deductible PPO "saves money" or "comes out ahead" compared to the HDHP.

At my company, there are almost no scenarios where that is the case. The premiums are so high, that premiums+deductible/OOP max for the PPO ends up being the same on the HDHP, IF you hit your OOP max. The variable is drug costs that aren't covered/subsidized by the HDHP.

This would vary plan to plan, though, based on specifics.

BenTheGoodAg said:

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AgsMyDude said:

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I'll disagree on the first point that there is no situation.

I ran the numbers many, many times and childbirth absolutely is a situation where it makes sense. The HDHP came nowhere close to touching the benefits on the lower premium option when our wife gave birth to our kids.

The max out of pocket was higher, etc.

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I'm really confused on this statement. I've had several kids under a HDHP and it was either the same as or cheaper than the PPO in terms of total cost out my pocket. Isn't the HDHP typically lower premiums than a PPO or other plan?

This may be company specific, but every one I've seen, the HDHP (lower premiums + max out of pocket) is roughly equal to the PPO (higher premiums + co-pays) in years where you hit the max out of pocket. In years you don't hit max out of pocket, the HSA money gets pocketed, so the HDHP comes out ahead in most years..

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Maybe your HDHP is better than what my company offers. Yes the premium is lower but for the max out of pocket is much higher. The total cost when considering premiums, max out of pocket, etc. made it a poor choice for years when something high cost was planned.

I was confused by the bolded part. Should that say something different?

Didn't realize it was bolded.

And yep I was moving too quickly and didn't proofread.

I meant lower deductible option*

My bad

No worries! Thanks for clarifying

My wife has her and the kids on a Cadillac HDHP through her job. The cost of going from "employee + kids" to "family" is around $300/mo. My company subsidy 100% covers my HDHP premium on our company plan, so we are on separate plans.

Despite this $0 premium and the ability to contribute to an HSA, most of the single employees at my firm avoid the HDHP (and HSA).

My wife and I do our own hdhp so we get both company matches.

Both of them have the same max out of pocket as our alternative option ppo plans.

at a small company with only low deductible/PPO with zero premium (even with full family coverage) and min out of pocket for anything, I would still opt for a HDHP if it were an option just to be able to contribute to HSA, and still looking for some backdoor/loophole to be able to contribute
other than annual physicals I visit doctor maybe once every couple years for anything else

P.H. Dexippus said:

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My wife has her and the kids on a Cadillac HDHP through her job. The cost of going from "employee + kids" to "family" is around $300/mo. My company subsidy 100% covers my HDHP premium on our company plan.

Despite this most of our single employees of all ages avoid the HDHP (and HSA).

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My company really does not want to insure spouses who have access to their own insurance. Our plans have a surcharge if you add a spouse who can get their own insurance through their employer. It's a pretty significant extra fee.

The fee is waived if your spouse doesn't work or doesn't have access to health coverage.

TXTransplant said:

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P.H. Dexippus said:

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My wife has her and the kids on a Cadillac HDHP through her job. The cost of going from "employee + kids" to "family" is around $300/mo. My company subsidy 100% covers my HDHP premium on our company plan.

Despite this most of our single employees of all ages avoid the HDHP (and HSA).

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My company really does not want to insure spouses who have access to their own insurance. Our plans have a surcharge if you add a spouse who can get their own insurance through their employer. It's a pretty significant extra fee.

The fee is waived if your spouse doesn't work or doesn't have access to health coverage.

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how would they check something like this?

This seems borderline illegal, or breaking some sort of privacy laws.