No, and that's the whole point of running the numbers. It's tempting to assume the low-deductible PPO wins whenever you'll use a lot of care, but it depends on four things at once: the worker premium of each plan, each plan's out-of-pocket maximum, how much care you actually use, and the HSA benefit on the HDHP side. In a high-spend year like childbirth, both plans often hit their out-of-pocket max, so the comparison frequently collapses to: worker premium plus OOP max on each side, minus the HDHP's HSA tax saving and any employer HSA contribution. Sometimes that favors the HDHP, sometimes the PPO. This tool computes both and tells you which. It never assumes an answer.

Exactly the way a plan works. Your medical spend is applied to the deductible first, which you pay in full. Above the deductible you pay the coinsurance share (say 20%) until your spending reaches the out-of-pocket maximum, after which the plan pays 100%. In formula terms: out-of-pocket = the smaller of (deductible + coinsurance × (spend − deductible)) and the out-of-pocket maximum. We add that to your annual worker premium to get each plan's total, then subtract the HSA benefit on the HDHP.

Use the total allowed cost the plan processes for the year, not what you expect to pay out of pocket (plan design already caps that). The presets come from the Peterson-KFF Health System Tracker: about $15,712 for an uncomplicated vaginal birth, $28,998 for a C-section, a blended average of $19,964 weighting the ~32% US C-section rate, and a $77,992 NICU stress test. Those are averages for employer-insured births and exclude Medicaid and balance bills. Add any other care you expect that year (existing conditions, other family members) for a fuller picture.

The HSA lowers the net cost of choosing the HDHP in two ways. First, money you contribute is deducted from your income, so it saves you tax at your marginal rate: a $4,000 contribution at a 25% combined rate is worth about $1,000. Second, any employer HSA contribution is simply free money. We subtract both from the HDHP's total. Two cautions: California and New Jersey don't give a state HSA deduction, and the 7.65% FICA saving only applies to contributions made through payroll, so your real benefit may be a bit lower than a flat marginal-rate estimate. And crucially, the HSA offsets the HDHP's cost but doesn't remove the risk: you still need to be able to front the higher deductible when the bills land.

Yes, and it's a common trap. Many family HDHPs are non-embedded, meaning the entire family deductible must be met before coinsurance kicks in for anyone: one person can't meet just their own individual deductible first. In a birth year that usually isn't decisive because you're likely to blow past the deductible anyway, but it matters a lot in lower-spend years. Check whether your plan is embedded or non-embedded, and enter the deductible that actually applies.

No. The comparator runs entirely in your browser and stores nothing on our servers: there's no email box and no sign-up. Your inputs are only reflected in the page's web address so you can bookmark, share, or print your result; clear the link and they're gone.