Twenty-seven receipts are paper-clipped by month inside a manila envelope on my desk. On Sunday night, with open enrollment for 2027 now open at work, I finally added them up.
Last November we left the PPO for a high-deductible plan with a health savings account, and I promised a report with real receipts. It isn't quite a full year, since the totals below run from January 1 through October 16, but our elections are due in a few weeks and this is the number that decides them.
What we spent, and what the HSA covered
Here's what the three of us paid out of pocket in 2026 so far for medical, dental and vision:
- Doctor visits, one urgent care trip with an X-ray, and lab work: $1,250
- Prescriptions: $190
- Dental: $460
- Vision, exams and one pair of glasses: $280
- Total: $2,180
We never came close to the $3,400 family deductible, and every dollar above came out of the HSA. On the money side, we put in $250 a month, $2,500 so far, and my company added its $750 in January. That's $3,250 in, $2,180 out and about $1,075 left, plus a few dollars of interest. If November and December stay quiet, we'll carry roughly $1,575 into 2027, and that money stays ours.
Ben's rule from last fall held: nobody skipped a visit because of the plan. The urgent care trip in September was the real test. It came to about $260 at the negotiated price, and nobody hesitated.
Day to day, the HSA was less work than I expected. It came with a debit card we used at the pharmacy counter and the dentist's front desk. Twice I paid with our regular card out of habit and reimbursed us from the HSA later, which took about five minutes each time. The bigger change was in my head. The insurance website lists the negotiated price for common visits, and checking it before an appointment took most of the sting out of the bill when it came.
Did it pay off?
To compare, I re-priced every receipt the way the PPO would have handled it: $30 copays for visits, the old copays for prescriptions, and the same dental and vision costs, since those plans didn't change. Then I added the premiums for the full year.
| PPO, if we'd stayed | High-deductible + HSA | |
|---|---|---|
| Premiums for 2026 | $8,268 | $4,914 |
| Out of pocket, Jan. 1 to Oct. 16 | about $1,220 | $2,180 |
| Money from my company | $0 | -$750 |
| Total so far | about $9,488 | $6,344 |
So far we're about $3,100 ahead, and almost all of it is the premium. The $129 a paycheck we stopped sending to the PPO did the heavy lifting. The HSA's job was to make the deductible feel like a plan instead of a threat, and it did that.
Over my years in HR I saw two kinds of high-deductible regret: people who picked it and then put off care, and people who picked it and never set up their HSA contribution, so the deductible came straight out of checking. We avoided both, mostly because we decided about both on day one.
Keeping it for 2027, with one caveat
We're staying on the high-deductible plan for 2027 and keeping the HSA contribution at $250 a month. Premiums went up a little on both plans for next year, and the gap between them is about the same.
The caveat is a bad year, especially a bad January. If someone in our house needed surgery or a trip to the emergency room early in the year, the bill would arrive before the HSA had much in it, and we'd be paying toward the out-of-pocket maximum with emergency-fund money. In our house, the deductible and the emergency fund are the same conversation, and the emergency fund is in much better shape than it was a year ago. If one of us had a planned procedure or a new ongoing prescription on the horizon, I'd rerun the whole spreadsheet before choosing.
The receipts envelope goes back in the drawer, and a new one marked 2027 goes next to it.
One year and one family isn't a trend. Health plans depend on your own year, so this is our receipt envelope, not a recommendation.
