The Deuce: Yeah I’d try running the numbers the next time you’re in open enrollment

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Yeah I’d try running the numbers the next time you’re in open enrollment

Posted by snipes824

on October 30, 2025, 13:26:08, in reply to "Yeah, gotcha."

What do you pay now (something you already know), and then game out the new scenario using the HDHP numbers. A $6,500 deductible but you save $3,500 in premiums with a better coinsurance rate could easily have you come out better at the end of the year in both low use and high use scenarios.

But also possibly not. Need to game out the scenarios with the actual numbers.

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I don't recall what the premiums on an HDHP would be, but our family PPO now is ~$390 monthly. Will soon find out what the increase will be as we need to decide by November 7th.

And future congrats on the planning.

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For me, the premium for my wife and I on the HDHP is $0/month (fully covered by my work), and the PPO for my wife and I is $310/month.

The PPO has $1000 deductible and 80% coinsurance, the HDHP has $6600 deductible and 90% coinsurance.

On a year with a $20k pregnancy and nothing else:

PPO Calculation

Premiums:
$310/month × 12 = $3,720

Medical costs:
Deductible: $1,000
Remaining: $20,000 − $1,000 = $19,000
Coinsurance (you pay 20%): 0.20 × $19,000 = $3,800

Total medical out-of-pocket: $1,000 + $3,800 = $4,800

PPO Total Cost = $3,720 + $4,800 = $8,520

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HDHP Calculation

Premiums:
$0/month × 12 = $0

Medical costs:
Deductible: $6,600
Remaining: $20,000 − $6,600 = $13,400
Coinsurance (you pay 10%): 0.10 × $13,400 = $1,340

Total medical out-of-pocket: $6,600 + $1,340 = $7,940

HDHP Total Cost = $7,940

The coinsurance and premium difference does the heavy lifting here. So not every HDHP will come out ahead in this scenario. But you can see in certain situations that it can.

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Can I ask your relative difference in premiums from PPO to HDHP?

Maybe I'm looking at this all wrong.
Or we have relatively inexpensive insurance.

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max out of pocket, and what services you typically use throughout the year.

It’s a simple calculation from there that AI could easily help you with.

For instance, the HDHP is going to be cheaper for us in a pregnancy year than the PPO, due to the sky high premiums for the PPO. Which was counterintuitive when I began looking into it since it’s going to be a high usage year.

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Anyone know of a good calculator to compare past costs to see which plan we'd be better off with? (Not certain our plan selection website has one.)

Also, reasons why we haven't switched...
1) I'm risk adverse.
2) I'm getting old.
3) Don't recall premium savings being that much. Maybe $1500 to $2000 a year for family coverage.
4) We have several hundred dollars of labs drawn annually which end up just a $25 to $30 co-pay. This year a daughter had a few thousand in labs drawn that ended up costing a few hundred. If it would have all been out of pocket with a HDHP, we easily made up the premium difference.
5) We don't (can't) max out our 401(k)s & Roth IRAs as it is. No way we'd be able to take advantage of maxing out a HSA to use as an IRA.
6) In the past with the PPO we had a pre-tax savings from the plan that had to spent on healthcare. Catch was it was capped and had to be used in that calendar year. Now, it appears we may have an HSA (at least that what it's called) even with our PPO. Probably will not get the potential retirement savings, but still will have pre-tax savings that can be spent on healthcare.