Hi, Currently deciding between a high deductible plan and PPO for medical insurance. Pretty sure I understand the differences, pros/cons etc, but I keep seeing advice (or people's experience) that it makes more sense to go with PPO if you have a family. BH we are a family of 6, but am still leaning towards HDP - the difference in premium between that and the PPO is ~$3000. I understand that my OOP costs will be higher, but won't I have more cashflow since less will be going towards the premium? In the past we've had moderate usage, which indicates to me that in a low usage year, we would come out ahead, and in a higher usage year, we would be spending around the same as we would for PPO. (With the additional benefit of the HSA...) Anything I'm missing when thinking about this? Is the advice to go with a PPO for a family more of a psychological one than anything else?

For me HDP was definitely cheaper but I have some expected things which are going to max out my deductible very quickly. GPT can help do some quick scenario analysis if paste in your plan info (if you don't have a calculator/simulator included in your benefits management platform)

I think yes- people instinctively go towards the low deductible plan for emotional/psychological reasons, especially when they have a family

@straight-nightfall-20143 That's the thing - I do have that simulator, and based on my usage this past year, it's telling me the HDP will be slightly cheaper. Given this past year was on the higher end of our usage, I would think that in the case that we do use less this coming year, the savings would be more significant. Obviously only Hashem knows so need to account for that, but even when simulating high usage, the HDP comes out cheaper... @incalculable-toothbrush-90475 Thank you, that's helpful! In this case the PPO's deductible is much much lower, but I have found in past experience that it was pretty challenging to even mee the deductible even with relatively frequent dr's visits since all they charge is a copay, which doesn't count toward the deductible. And re: HSA, yes, that's why the high deductible plan is so appealing to me, I feel like the benefits of that are kind of outweighing the emotional/psychological benefits of the PPO

Totally get this. We went through a similar process a few years ago and decided to go with the HD plan. I spoke to other people about the decision in advance and they were saying things like "but you have to take care of your family!"

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The analysis is non-trivial. Tax savings on the HSA. Difference in premium is pre-tax, but medical expenses are generally after tax. I download my claim history from prior years and run an as-if to see what would have happened. In my case, it's fairly reasonable to assume I will hit the max oop on either plan, and they're the same, so it's a no-brainer. But every employer and family is an entirely different story

we've always used the high deductible plan, between the reduced premiums and my employer contribution to hte HSA It made more sense. The one thing to look out for, is in some HDPs, you do not hit an individual deductible/OOP until you hit the family one, So if you expect a bunch of medical exepnses to be concentrated on one family member -- like giving birth, or a planned surgery or treament -- the PPO plan would have made more sense due to the individual deductible

I think a rule of thumb that should be close to correct is if you have low medical expenses or high medical expenses, good chance HD makes sense. Average medical expenses, HD might be more expensive

Thank you! @nutritious-raincoat-28876 , is there a way to run an accurate as if analysis for the hdp part if you were on the PPO plan previously? Part of what's unclear to me is estimating what prescriptions or a Drs cost might cost, as opposed to PPO which I will just know what the copay would be

Aetna allows me to download a CSV file with claim history. The key number there is the insurance-approved amount, which is what the plan paid plus what you paid. That number can be used to calculate what you would have paid under HD. There are also generally data points that need to be manually adjusted. Like visits that are always covered at 100% I did this in Stata - pandas/polars would also work, as would excel, although excel is a little messier for this

I'm evaluating the same question now (HDHP vs PPO). For those following, just want to point out that not all HDHP plans will have a lower premium than PPO. While everything mentioned above is true, be sure to check the details of your plan options carefully before assuming that the above conclusions apply to you too. In my case, I'm offered two HDHP plans: one with a very low premium but extremely high deductible & OOPM, and a 2nd one with a premium that is only about $10/paycheck less than the PPO plan. The main savings with the 2nd HDHP plan is the long-term HSA benefits and an aggregate (family-wide shared) deductible, compared to the PPO with individual deductibles and no HSA.