HDHP vs PPO Calculator: Find Your Break-Even Point in 2026
Enter your actual plan numbers to see which health plan costs less for your situation. This calculator factors in what most tools ignore: employer HSA contributions, your tax bracket savings on HSA contributions, and the long-term investment growth of your HSA balance.
Results update in real time as you change inputs. Try the scenario presets below to see typical outcomes for different life stages, then customise with your own numbers from your employer's benefits summary.
Monthly Premiums
Plan Details
Your Situation
The HDHP costs less after factoring in HSA tax savings and employer contributions.
Annual Cost Breakdown
Visual Comparison
5-Year HSA Projection
If you contribute $4,400/year to your HSA plus $750 from your employer and invest at a 7% average annual return:
Projected HSA balance after 5 years (tax-free growth)
How to Find Your Plan Numbers
Where to Look
Your employer provides a Summary of Benefits and Coverage (SBC) document during open enrollment. This standardised document includes every number you need for this calculator. You can usually find it in your benefits portal under “Plan Documents” or “Benefits Summary.”
If you are comparing marketplace plans, the plan details page on Healthcare.gov shows the monthly premium, deductible, out-of-pocket maximum, and coinsurance rates. Bronze plans on the marketplace are now HSA-eligible as of 2026.
Key Numbers to Find
- Monthly premium (your share after employer contribution)
- Annual deductible (individual or family)
- Out-of-pocket maximum (your annual spending cap)
- Coinsurance rate (typically 80/20 or 90/10)
- Employer HSA contribution (if choosing HDHP)
- Copay amounts for office visits and specialists (PPO)
Methodology and Assumptions
HDHP cost model: You pay full cost for medical services until the deductible is met. After the deductible, coinsurance applies at 80/20 (you pay 20%) up to the out-of-pocket maximum, after which the plan covers 100%. Preventive care is covered at 100% regardless of deductible status.
PPO cost model: Routine office visits incur a flat copay (modelled at approximately $30/visit). For major medical expenses, the deductible applies first, followed by coinsurance at 80/20 up to the out-of-pocket maximum. Copays typically do not count toward the deductible.
HSA tax savings: Calculated as your HSA contribution multiplied by your marginal federal tax rate plus FICA (7.65%). This assumes contributions are made via pre-tax payroll deduction. If you contribute post-tax, you still get the income tax deduction but not the FICA savings.
HSA investment return: The 5-year projection uses a 7% nominal annual return, which approximates the historical average real return of a diversified US stock index fund. Actual returns will vary. No fees are deducted in the projection; choose a no-fee HSA provider like Fidelity to minimise fee drag.
Limitations: This calculator does not account for state income tax savings (varies by state; California and New Jersey do not recognise HSA deductions), specific prescription drug costs, or network-related cost differences between plans. It also does not model the value of PPO out-of-network coverage.
For a more detailed breakdown of how these calculations work, including the compounding assumptions and cost modelling methodology, see our HSA benefits guide and premium savings data.
Calculator FAQ
How do I find my HDHP and PPO premium amounts?
Check your employer's benefits enrollment portal or the Summary of Benefits and Coverage (SBC) document provided during open enrollment. Look for the 'Employee Monthly Premium' or 'Your Cost Per Pay Period' line. If you are paid biweekly, multiply by 26 and divide by 12 to get the monthly amount.
How does an employer HSA contribution affect my choice?
Employer HSA contributions ($500-$2,000/year is common) directly reduce your effective HDHP cost. This money is tax-free to you and counts toward your annual HSA limit. A $1,000 employer HSA contribution can shift the break-even point by $1,000-$1,500 when you factor in the tax savings on top of the direct contribution.
What assumptions does this calculator make?
The calculator assumes 80/20 coinsurance after deductible for HDHP, PPO copays of approximately $30 per visit for routine care plus 80/20 coinsurance for major expenses, 7% average annual return on HSA investments, and that FICA savings (7.65%) apply to HSA contributions made via payroll deduction. Adjust inputs to match your specific plan documents.
Why does this calculator include a 5-year HSA projection?
Most HDHP vs PPO comparisons only look at one year. But the HSA's true value is compounding over time. Even if the HDHP costs slightly more in year one, the HSA's tax-free investment growth often makes it the clear winner over 3-5 years. Our 5-year projection shows the total financial picture including investment returns.