The calendar reminder popped up at 6:40 on a Monday morning: "Benefits elections due Friday, 5 p.m." I'd been dismissing its smaller cousins for two weeks.
I ran open enrollment sessions at the hospital for seven years, so I know what most people do at this point. They pick the same plan as last year, and if they change anything, it's because a coworker did. I've done both. This year I finally did what I used to suggest from the front of a cold conference room and ran our actual numbers.
The two plans
My company offers two medical plans for 2026. We've been on the PPO since I started. The other option is a high-deductible plan paired with a health savings account. Our dental and vision plans are separate, and nothing about them changed.
| 2026 option | PPO | High-deductible + HSA |
|---|---|---|
| Premium per paycheck (family) | $318 | $189 |
| Premiums for the year | $8,268 | $4,914 |
| Family deductible | $1,500 | $3,400 |
| Family out-of-pocket maximum | $6,000 | $7,000 |
| Sick visit before the deductible | $30 copay | Full negotiated price |
| Money from my company | $0 | $750 into the HSA |
Before any math, I checked the one thing that could have ended the conversation: whether our doctors, Harper's pediatrician and the urgent care closest to our house were covered on the new plan. They were, because both plans use the same network. If they hadn't been, nothing below would have mattered.
The premium difference is $129 a paycheck, or $3,354 a year. My company also puts $750 into the HSA. That's real money before anyone so much as sneezes.
Last year's actual spending, priced both ways
I pulled our 2024 claims from the insurance website, every visit and prescription for the three of us, and added up two numbers: the total the plan had agreed to pay for our care, $2,350, and what we actually paid out of pocket on the PPO, $1,240.
On the high-deductible plan, almost all of that $2,350 would have been ours, since we'd have stayed under the deductible all year. Checkups and other preventive visits are covered on both plans, so those didn't move the comparison.
So for a year like 2024, the PPO cost us $8,268 in premiums plus $1,240 in care, or $9,508. The high-deductible plan would have been $4,914 plus $2,350, minus the $750 from my company, or $6,514. Then I ran the scary version, a year where we hit the out-of-pocket maximum. The PPO comes to $14,268. The high-deductible plan comes to $11,164. On paper, it came out ahead in the good year and the bad one.
What worried me, and what we decided
The math was the easy part. Three things still bothered me.
- January. The deductible starts over on January 1, and the HSA starts with only my company's money in it. A big bill in February would arrive before our own contributions build up. Our answer is the emergency fund, which is around $12,500 now and exists for exactly that kind of month.
- Full price for ordinary visits. I looked up what a typical sick visit costs at the plan's negotiated rate: about $140, compared with a $30 copay. That's the number that makes people wait a few days to see if something goes away.
- Skipping care to save money. Ben sees what a skipped visit turns into for a living, and he settled this one: "Nobody in this house skips a visit because of the plan." That's the rule.
Here's how the HSA works for us. We'll put in $250 a month from my paycheck, which with my company's $750 comes to $3,750 for the year, a little more than the $3,400 family deductible. And the $250 isn't coming out of the grocery line. The premium drop is about $280 a month, so the money that used to go to the PPO now goes to the HSA instead, with a little left over.
I'm adding an HSA tab to our spreadsheet, and every receipt goes into one envelope on my desk. Future me will want them.
We submitted our elections Wednesday night, two days early, which for me and open enrollment is practically a personality change. I'll report back after a year with the actual receipts.
Health plans depend on your own medical year, your family and your budget. This is how we decided for ours, not a recommendation for yours.
