Health Insurance Cost Comparison

Q: What is the difference between HMO, PPO, and HDHP?

HMO (Health Maintenance Organization): requires a primary care physician (PCP) and referrals; lowest premiums; network-only coverage. PPO (Preferred Provider Organization): no referrals needed; can see out-of-network doctors (at higher cost); more flexible, higher premiums. HDHP (High Deductible Health Plan): high deductible ($1,650+ single); low premiums; qualifies you for an HSA (tax-free savings for medical costs).

Q: What is a deductible vs out-of-pocket maximum?

Deductible: amount you pay before insurance kicks in. Once met, you pay copays/coinsurance. Out-of-pocket maximum: the most you'll pay in a year. Once hit, insurance covers 100%. In 2025, the ACA out-of-pocket maximum is $9,200 (individual) / $18,400 (family). HDHPs must have a deductible of at least $1,650 single.

Q: When does an HDHP with HSA make sense?

HDHP + HSA makes sense when: you're generally healthy (few expected claims), you can afford to fund the HSA, you're in a medium-high tax bracket (HSA gives triple tax benefit), or you want to invest HSA funds for retirement. Young, healthy people often save $1,000-3,000/year vs a PPO.

Q: What is coinsurance?

Coinsurance is your share of costs AFTER meeting the deductible, expressed as a percentage. 80/20 coinsurance means insurance pays 80%, you pay 20%. You keep paying your 20% share until you hit the out-of-pocket maximum.

By CalcMesh Editorial · Reviewed against primary-source formulas

Plan Type Quick Reference

Feature	HMO	PPO	HDHP
Premiums	Low	High	Lowest
Referrals needed	Yes	No	No
Out-of-network	Not covered	Higher cost	Varies
HSA eligible	No	No	Yes
Best for	Predictable care	Specialist access	Healthy, savers

Related Data

Compare health insurance plan availability and costs by state at HealthCare.gov. See healthcare access metrics by county at HealthData.gov.

Disclaimer: This is a simplified estimate. Actual costs depend on your specific plan's copays, coinsurance rates, and network usage. Review your full plan documents before enrolling.

U.S. Health-Insurance Landscape

The 2023 Kaiser Family Foundation Employer Health Benefits Survey found annual premiums for employer-sponsored family coverage averaged $23,968 ($6,575 employee / $17,393 employer) — up 22% since 2018. Single coverage averaged $8,435 ($1,401 employee share). Workers at small firms (<200 employees) pay 22% more out of pocket for family coverage than those at large firms.

Deductible trends reshape choice. 85% of covered workers have a deductible, averaging $1,735 for single coverage — up from $826 in 2008. High-Deductible Health Plans (HDHPs, ≥$1,600 single / ≥$3,200 family for HSA eligibility in 2024) now cover 29% of employer-sponsored enrollees versus just 4% in 2006. Total out-of-pocket maximums under ACA can reach $9,450 individual / $18,900 family for 2024.

Marketplace plans show similar pressure. CMS reported the 2024 benchmark Silver plan averaged $477/month for a 40-year-old before subsidies, with 91% of marketplace enrollees receiving premium tax credits averaging $527/month. Bronze plans offer the lowest premiums ($384/month average) but highest deductibles (often $7,000+); Gold and Platinum plans cost 20-40% more monthly but cap deductibles at $500-$1,500.

Sources: KFF Employer Health Benefits Survey 2023, CMS Marketplace Open Enrollment Report

Methodology & Assumptions

This calculator implements standard formulas drawn from primary-source authorities. Values are point-in-time estimates; consult a licensed professional for high-stakes decisions. See the per-input definitions and source citations below.

How this works

Computations are deterministic and run client-side — no inputs leave your browser. Formulas are derived from standard published formulas for the calculator's domain (mortgage, taxes, energy, conversions, etc.). When the underlying agency publishes updated rates or thresholds we refresh defaults and update the page's lastmod timestamp.

Frequently Asked Questions

What is the difference between HMO, PPO, and HDHP?

HMO (Health Maintenance Organization): requires a primary care physician (PCP) and referrals; lowest premiums; network-only coverage. PPO (Preferred Provider Organization): no referrals needed; can see out-of-network doctors (at higher cost); more flexible, higher premiums. HDHP (High Deductible Health Plan): high deductible ($1,650+ single); low premiums; qualifies you for an HSA (tax-free savings for medical costs).

What is a deductible vs out-of-pocket maximum?

Deductible: amount you pay before insurance kicks in. Once met, you pay copays/coinsurance. Out-of-pocket maximum: the most you'll pay in a year. Once hit, insurance covers 100%. In 2025, the ACA out-of-pocket maximum is $9,200 (individual) / $18,400 (family). HDHPs must have a deductible of at least $1,650 single.

When does an HDHP with HSA make sense?

HDHP + HSA makes sense when: you're generally healthy (few expected claims), you can afford to fund the HSA, you're in a medium-high tax bracket (HSA gives triple tax benefit), or you want to invest HSA funds for retirement. Young, healthy people often save $1,000-3,000/year vs a PPO.

What is coinsurance?

Coinsurance is your share of costs AFTER meeting the deductible, expressed as a percentage. 80/20 coinsurance means insurance pays 80%, you pay 20%. You keep paying your 20% share until you hit the out-of-pocket maximum.