Guides How to choose a health plan
How to choose a health plan at open enrollment
The plan with the lowest premium isn't always the cheapest, and neither is the one with the lowest deductible. To pick, add up what each plan would cost you over a whole year. Here's how, step by step.
The one number to compare
For each plan you can choose, work out a yearly total:
premiums for the year + what you'd pay for care − any money your employer puts in your HSA
Then look at it twice: in a year like your last one, and in a bad year, when you'd pay the full out-of-pocket maximum. The best plan is usually the one that's cheapest in a normal year without being much worse in a bad one.
Step by step
Add up each plan's premiums for the year
Your benefit guide shows what comes out of each paycheck. Multiply by the paychecks in a year: 26 if you're paid every two weeks, 24 if twice a month, 52 if weekly. Use the coverage level you need: just you, you and a spouse, you and your children, or family.
Estimate your care from last year's claims
Sign in to your insurer's website and download your claims. Use the allowed amount (the price your plan negotiated), not the billed amount. Split it into preventive care, which is usually free on every plan, office and specialist visits, prescriptions, and anything bigger, like imaging or a procedure.
Price that care under each plan
On a copay plan, a visit costs the copay. On a deductible plan, you pay the full negotiated price until you reach the deductible, then a share (coinsurance, often 20%) until you reach the out-of-pocket maximum. Check whether prescriptions count toward the deductible or have their own copays.
Count your employer's HSA money
Many employers put money into the health savings account that comes with a high-deductible plan. It's yours to keep, it rolls over every year, and it offsets what you pay. Money you add yourself goes in before taxes.
Check the worst case
Add each plan's premiums to its out-of-pocket maximum and subtract the HSA money. On family coverage, check whether each person has their own deductible inside the family one (embedded) or the whole family deductible has to be met first. It changes how fast one person's big bill gets covered.
Check what could change the answer
Make sure your doctors, hospital and prescriptions are covered in network on each plan. Think about what's coming: a baby, a surgery, a new diagnosis. If your spouse has coverage through work too, compare every way you could enroll; see your plan or your spouse's.
A worked example
Made-up numbers for one person choosing between a PPO and a high-deductible plan with an HSA, paid every two weeks. Last year's care came to $2,400 at negotiated prices: six office visits at $150 each and one MRI at $1,500.
- PPO: $120 a paycheck, $1,000 deductible, 20% coinsurance, $4,000 out-of-pocket maximum, $30 office visit copay.
- HSA plan: $45 a paycheck, $3,500 deductible, 20% coinsurance, $7,000 out-of-pocket maximum, $1,000 a year from the employer into the HSA.
| PPO | HSA plan | |
|---|---|---|
| Premiums for the year (26 paychecks) | $3,120 | $1,170 |
| Your share of last year's care | $1,280 | $2,400 |
| Employer HSA money | $0 | −$1,000 |
| Total in a year like last year | $4,400 | $2,570 |
| Total in a bad year (out-of-pocket maximum) | $7,120 | $7,170 |
On the PPO, the six visits cost $30 each ($180) and the MRI costs the $1,000 deductible plus 20% of the remaining $500 ($1,100). On the HSA plan, all $2,400 falls under the deductible. In this example the HSA plan costs $1,830 less in a year like the last one, and only $50 more in a bad year.
Try your own two plans in the HSA vs PPO calculator.
2027 numbers to know
| 2027 limit | Just you | Family |
|---|---|---|
| Most you can put in an HSA (employer money counts toward it) | $4,500 | $9,000 |
| Extra HSA contribution if you're 55 or older | $1,000 | $1,000 each |
| Lowest deductible an HSA-eligible plan can have | $1,750 | $3,500 |
| Highest in-network out-of-pocket maximum for an HSA-eligible plan | $8,700 | $17,400 |
| Highest in-network out-of-pocket maximum for most other plans | $12,000 | $24,000 |
HSA and HDHP figures: IRS Rev. Proc. 2026-24. Out-of-pocket maximum for most plans: CMS. The 55-and-older amount is set in law and doesn't change with inflation.
One catch for couples: if your spouse has a general health FSA through their job, you can't put money into an HSA, even on an HSA-eligible plan. A limited-purpose FSA, for dental and vision only, doesn't cause that problem.
Before you enroll: a checklist
- Each plan's premiums at the coverage level you need, for a full year
- The last 12 months of claims, at allowed amounts
- Your doctors, hospital and prescriptions, checked in each plan's network and drug list
- Your employer's HSA deposit, if any
- Whether family deductibles are embedded
- A spouse's plan, and any spouse surcharge or pay for turning a plan down
Do it with your own numbers
HerePup reads your employer's benefit guide and your claims, prices every visit and prescription under every plan you can choose, and shows the total for each, in a normal year and a bad one.
Free. Your benefit guides and claims are read on your device and never uploaded.
Questions people ask
Is a high-deductible plan with an HSA worth it?
Often, if you expect little care and your employer puts money in the HSA: lower premiums plus the deposit can outweigh a higher deductible. Check the worst case too, premiums plus the out-of-pocket maximum minus the HSA money, and make sure you could cover the deductible if you needed to.
What's the difference between the deductible and the out-of-pocket maximum?
The deductible is what you pay for covered care before the plan starts sharing the cost. The out-of-pocket maximum is the most you'll pay in a year for covered, in-network care, counting the deductible, copays and coinsurance. Premiums don't count toward either.
Should I just pick the plan with the lowest premium?
Not without checking. The lowest premium usually comes with the highest deductible. Add each plan's premiums for the year to what you'd likely pay for care, subtract any employer HSA money, and compare those totals.
Can I change my health plan outside open enrollment?
Usually only after a qualifying life event, such as marriage, a birth or adoption, or losing other coverage. Employer plans must give you at least 30 days after a birth, adoption or marriage to make the change.