Health calculator

Health Insurance Cost Comparison, HMO vs PPO vs HDHP

Compare total annual cost of HMO, PPO, and HDHP health insurance plans based on premiums, deductibles, and expected healthcare usage.

Published by · Reviewed against primary-source formulas

Your Expected Annual Healthcare Usage

HMO Plan

PPO Plan

HDHP Plan (HSA-eligible)

Annual Cost Comparison

How CalcMesh compares health plans

We compare plans on premium, deductible, copays and the out-of-pocket maximum, the most you can pay in a year before the plan covers 100%, a cap the Affordable Care Act requires every compliant plan to have.

We estimate total annual cost at your expected usage level so you can compare a low-premium, high-deductible plan against the reverse; the assumptions we use are listed in our methodology.

For 2026, CMS sets the maximum annual cost sharing for covered essential health benefits at $10,600 for self-only coverage and $21,200 for other-than-self-only coverage. HSA eligibility has separate IRS rules: a qualifying HDHP needs at least a $1,700 self-only deductible or a $3,400 family deductible. These are federal limits, not a substitute for the benefits, network, and cost-sharing terms of a specific plan. See the CMS 2026 cost-sharing guidance and IRS Revenue Procedure 2025-19.

Plan Type Quick Reference

Feature HMO PPO HDHP
PremiumsLowHighLowest
Referrals neededYesNoNo
Out-of-networkNot coveredHigher costVaries
HSA eligibleNoNoYes
Best forPredictable careSpecialist accessHealthy, 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.

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): often uses a primary care physician and network rules. PPO (Preferred Provider Organization): usually offers more provider-choice flexibility, including some out-of-network coverage at a higher cost. HDHP (High Deductible Health Plan): a 2026 HSA-qualifying plan must have a deductible of at least $1,700 for self-only coverage or $3,400 for family coverage. Plan networks and referral rules vary, so review the plan documents.
What is a deductible vs out-of-pocket maximum?
Deductible: the amount you generally pay for covered care before a plan begins sharing more costs. After that, copays or coinsurance can still apply. The out-of-pocket maximum limits covered essential-health-benefit cost sharing in a plan year. For 2026, the ACA maximum is $10,600 for self-only coverage and $21,200 for other-than-self-only coverage; premiums and services outside the limit can still be separate. Check your plan documents for the exact rules.
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.

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This page identifies the inputs, method, and limitations behind its estimates. Calculator outputs are not professional advice and should be checked against the relevant primary source for a consequential decision. This calculator's formula and defaults are drawn from standard published sources for its domain, no figure is typed in by an editor. See our editorial standards & corrections policy, the methodology behind these numbers, or report a data error.

Inputs, defaults, and authoritative sources
Input Default Source / authority
All inputs Domain-typical defaults Editorial methodology, CalcMesh 2026