Health Insurance Plan Comparison
Compare HMO, PPO, and HDHP plans based on premiums, deductibles, and expected usage.
Compare health plans side-by-side
Enter your expected medical usage and the details of each plan. Total annual cost = premiums + expected out-of-pocket (capped at the OOP max).
Sum of expected doctor visits, prescriptions, procedures (before insurance). Use the slider presets below for quick scenarios.
How to use this calculator
- Estimate your expected annual medical charges—the total billed amount you anticipate for doctor visits, prescriptions, and procedures before insurance. Use a preset scenario for a quick start.
- Enter each plan's monthly premium—what you pay regardless of usage.
- Enter each plan's annual deductible—what you pay out of pocket before insurance shares costs (except preventive care, which is free under ACA plans).
- Enter coinsurance—the percentage you pay of covered services after the deductible is met (e.g., 20% means you pay 20%, insurer pays 80%).
- Enter the annual out-of-pocket maximum—the hard cap on what you'd pay in a worst-case year.
- Click Compare to see total annual cost (premiums + expected OOP) for each plan side-by-side, plus a recommendation.
- Re-run with different usage scenarios—the cheapest plan often changes between healthy years and high-usage years.
How health plan total cost is calculated
Choosing a health plan by premium alone is the most expensive mistake people make during open enrollment. A $250/month plan with a high deductible can cost more than a $520/month plan if you actually use medical care. The right way to compare plans is by total annual cost: the sum of your premiums (paid no matter what) and your expected out-of-pocket spending (paid only if you use care).
The four numbers that drive cost
Every plan has four cost-sharing parameters that together determine what you'll actually pay:
- Premium: Fixed monthly cost—paid whether you see a doctor or not. Annual premium = monthly × 12.
- Deductible: The amount you pay in full for covered services before insurance starts sharing costs. ACA preventive care is exempt—you pay $0 for annual physicals, vaccinations, and screenings regardless of deductible.
- Coinsurance: After the deductible, you pay a percentage of each bill (commonly 10–30%) until hitting the OOP max.
- Out-of-pocket maximum: The hard annual cap. Once you've paid this much in deductible + coinsurance + copays, the insurer covers 100% of in-network covered services for the rest of the year.
The out-of-pocket calculation
For a given amount of expected billed charges, your out-of-pocket spending follows this logic:
if charges ≤ deductible: OOP = charges
else: OOP = deductible + (charges − deductible) × coinsurance%
OOP = min(OOP, OOP_max)
Total annual cost = (monthly premium × 12) + OOP. The cap at OOP max is what protects you in catastrophe years—and it's why high-deductible plans with low premiums can still be the right call for healthy households: the savings on premiums can exceed the higher OOP risk.
HMO vs PPO vs HDHP
HMOs offer the lowest premiums but require you to stay in-network and get referrals before seeing specialists. Best for budget-conscious users with simple, predictable needs. PPOs charge higher premiums in exchange for flexibility—see any specialist without a referral, with partial coverage even out-of-network. Best for those who value choice or have ongoing specialist care. HDHPs (High Deductible Health Plans) pair low premiums with high deductibles and unlock a Health Savings Account (HSA)—the rare triple tax-advantaged account. Contributions are pre-tax, growth is tax-free, and withdrawals for qualified medical expenses are tax-free. Best for healthy high earners who can pay current medical costs out of pocket and let the HSA grow for retirement healthcare.
The break-even way of thinking
Don't just ask "which plan is cheapest at my expected usage?" Ask "at what usage level does each plan win?" Run the comparison at low, medium, and high usage. If Plan A wins at $1,500 of charges and Plan B wins at $15,000, you have to assess the probability of each scenario. Healthy singles often benefit from HDHP+HSA; families with chronic conditions usually win with PPOs and lower deductibles. The HSA tax savings (often 25–35% effective) can swing the math further toward HDHPs for high earners.
Worked example
Scenario: A family expects $6,000 of billed medical charges this year. Comparing three plans:
- HMO: $350/mo premium, $2,000 deductible, 20% coins, $5,000 OOP max
- PPO: $520/mo premium, $1,000 deductible, 10% coins, $4,000 OOP max
- HDHP+HSA: $250/mo premium, $3,500 deductible, 20% coins, $5,500 OOP max
Annual premiums:
- HMO: $350 × 12 = $4,200
- PPO: $520 × 12 = $6,240
- HDHP: $250 × 12 = $3,000
Out-of-pocket on $6,000 of charges:
- HMO: $2,000 + ($6,000 − $2,000) × 20% = $2,800 (under $5k max)
- PPO: $1,000 + ($6,000 − $1,000) × 10% = $1,500 (under $4k max)
- HDHP: $3,500 + ($6,000 − $3,500) × 20% = $4,000 (under $5.5k max)
Total annual cost:
- HMO: $4,200 + $2,800 = $7,000
- PPO: $6,240 + $1,500 = $7,740
- HDHP: $3,000 + $4,000 = $7,000 (before HSA tax savings)
Result: HMO and HDHP tie at $7,000—before factoring HSA tax savings, which typically push HDHP ahead by $800–$1,200 for a 24% bracket household. PPO's flexibility premium costs ~$740 more this year but pays off in years with high usage.
Glossary
- Premium
- The fixed monthly amount you pay for coverage, regardless of whether you use medical services.
- Deductible
- The amount you pay in full for covered services before insurance begins sharing costs. Preventive care is exempt under ACA plans.
- Coinsurance
- The percentage of covered service costs you pay after meeting your deductible (e.g., 20% coinsurance = you pay 20%, insurer pays 80%).
- Out-of-Pocket Maximum
- The annual cap on deductible + coinsurance + copays. Once reached, the insurer covers 100% of in-network covered services for the rest of the year.
- HSA (Health Savings Account)
- A triple tax-advantaged account paired with HDHPs: pre-tax contributions, tax-free growth, tax-free withdrawals for qualified medical expenses.
- Total Annual Cost
- The true cost of a plan: annual premiums plus expected out-of-pocket spending. The only honest basis for comparing plans.
Frequently asked questions
Quick answers to the most common questions about health insurance plan comparison.
This calculator is provided for informational and educational purposes only and does not constitute financial, legal, tax, or professional advice. Results are estimates based on the inputs you provide and standard assumptions. Actual figures may vary. Please consult a qualified professional before making financial decisions. Read our full disclaimer.