Health Insurance Plan Comparison Spreadsheet: HMO vs PPO vs HDHP/HSA

Open enrollment arrives every year with the same problem: you are handed two, three, or four plan options — HMO, PPO, HDHP with HSA, maybe an EPO — each with a different premium, deductible, copay structure, coinsurance rate, and out-of-pocket maximum. The plan summaries are deliberately confusing. The “cheapest” plan by premium may be the most expensive plan by total annual cost if you actually use healthcare. And the plan that seems expensive might save you thousands through tax-advantaged savings.

Most people give up and pick the same plan they had last year. That decision costs American households hundreds — sometimes thousands — of dollars annually.

This spreadsheet eliminates the guesswork. You enter the real numbers from your available plans, estimate your expected healthcare usage, and the tool calculates your total annual cost under each plan for three scenarios: a healthy year, a moderate-use year, and a high-use year. It also models the tax benefits of HSA contributions, which most comparison tools ignore entirely.

The result: you can see exactly which plan costs less for your specific situation, not for some hypothetical average employee.

Disclaimer: This comparison tool is provided for informational and educational purposes only. It does not constitute insurance or financial advice. Consult a qualified insurance agent, benefits advisor, or tax professional before making healthcare coverage decisions. SpreadsheetTemplates.info is not responsible for decisions made based on the information provided.

Why Health Insurance Comparison Is Harder Than Other Insurance Types#

With auto or home insurance, you are comparing nearly identical products from different carriers. Health insurance is fundamentally different because the products themselves have different structures. An HMO, a PPO, and an HDHP are not different brands of the same thing — they are different financial architectures with different rules.

The Three Plan Architectures#

HMO (Health Maintenance Organisation): Lower premiums, smallest networks. You choose a primary care physician (PCP) who coordinates all care and must provide referrals for specialists. No out-of-network coverage except in emergencies. Predictable costs — flat copays for most services.

PPO (Preferred Provider Organisation): Higher premiums, largest networks. No PCP requirement, no referrals needed for specialists. Partial out-of-network coverage (at higher cost). The most popular plan type, accounting for roughly 46% of employer-based enrolment.

HDHP (High-Deductible Health Plan): Lowest premiums, highest deductibles. You pay full price for all non-preventive care until you reach the deductible (minimum $1,700 individual / $3,400 family in 2026). Eligible for an HSA, which provides triple tax benefits. Can operate within an HMO or PPO network structure.

The right choice depends entirely on how much healthcare you expect to use and your tolerance for financial variability.

The HSA Factor Most Comparisons Ignore#

The Health Savings Account is the single most tax-advantaged savings vehicle available to American workers, and most plan comparison tools either ignore it or treat it as a footnote. An HSA provides three tax benefits: contributions are tax-deductible (reducing your taxable income), growth is tax-free, and withdrawals for qualified medical expenses are tax-free.

In 2026, the contribution limits are $4,400 for individual coverage and $8,750 for family coverage, with an additional $1,000 catch-up contribution for those 55 and older. If your employer also contributes to your HSA, those contributions count toward the limit but represent free money that further reduces your effective plan cost.

For someone in the 24% federal tax bracket (plus state taxes), a $4,400 HSA contribution saves over $1,000 in taxes alone. That tax savings must be factored into any honest plan comparison. A plan with a $200/month higher premium than an HDHP may actually cost more once HSA tax savings are accounted for. Our spreadsheet models this explicitly.

A notable change for 2026: all ACA Marketplace Bronze and Catastrophic plans now qualify as HDHPs for HSA eligibility, broadening access to HSA tax benefits for individual market shoppers.

The Prescription Drug Blind Spot#

One of the most frequently overlooked comparison variables is prescription drug costs. Health plans organise drugs into tiers — typically generic, preferred brand, non-preferred brand, and specialty — each with different copay or coinsurance rates. Two plans with identical premiums and deductibles can differ by hundreds or even thousands of dollars annually based solely on how they cover your specific medications.

This matters most for people on ongoing prescriptions, particularly brand-name drugs or newer treatments like GLP-1 medications for weight management or diabetes. Some plans have copays of $30–$50 for preferred brands; others apply coinsurance of 25–50% of the drug’s cost, which can mean $200–$500 per month for expensive medications. Before comparing plans, make a list of every medication you take (including dosage and frequency) and check each plan’s formulary to see where your drugs fall in the tier structure.

The Network Adequacy Question#

A plan’s network determines which doctors, hospitals, and specialists you can see at in-network rates. A cheap HDHP with a narrow network is not a bargain if your preferred primary care doctor, your children’s paediatrician, or the nearest quality hospital are all out of network.

Before finalising any comparison, verify that your current providers are in-network for each plan option. Check the plan’s provider directory — not just the marketing materials, which may claim a “large network” without specifying whether your specific providers participate. For HMO plans, verify that you can designate your preferred primary care physician and that specialist referral pathways include the providers you need.

What the Spreadsheet Compares#

This is the most comprehensive health plan comparison tool on the site, reflecting the complexity of the decision.

Plan Cost Inputs#

For each plan (up to four), you enter the monthly employee premium contribution, the deductible (individual and family), copay amounts for primary care visits, specialist visits, urgent care, and emergency room, coinsurance rates (the percentage you pay after meeting the deductible), the out-of-pocket maximum, and prescription drug tier costs (generic, preferred brand, non-preferred brand, specialty).

Employer and HSA Inputs#

You enter your employer’s HSA contribution (if any), your planned HSA contribution, and your marginal federal and state tax rates. The spreadsheet uses these to calculate the effective after-tax cost of the HDHP option.

Healthcare Usage Scenarios#

The spreadsheet models three usage levels. In the low-use scenario, you have two to three primary care visits per year, one specialist visit, one or two generic prescriptions, and no significant procedures. In the moderate-use scenario, you have four to six primary care visits, two to three specialist visits, regular prescriptions including brand-name drugs, and one imaging procedure or outpatient procedure. In the high-use scenario, you have frequent doctor visits, multiple specialist consultations, ongoing prescriptions, and a significant event such as surgery, hospitalisation, or childbirth.

For each scenario, the spreadsheet calculates total annual premiums, out-of-pocket medical costs, HSA tax savings (if applicable), and the net total annual cost across all plans.

The Break-Even Calculator#

The spreadsheet also calculates the break-even point: the dollar amount of medical expenses at which one plan becomes cheaper than another. This is the most actionable output. If the break-even point between the HDHP and the PPO is $4,500 in medical expenses, and you typically spend $2,000, the HDHP is your better option. If you typically spend $7,000, the PPO wins.

How to Use the Spreadsheet#

Step 1: Gather your plan documents. You need the Summary of Benefits and Coverage (SBC) for each plan option. Your employer provides these during open enrollment; ACA Marketplace plans publish them on healthcare.gov. The SBC contains every number you need.

Step 2: Enter plan details. Input premiums, deductibles, copays, coinsurance, and out-of-pocket maximums for each available plan. Include prescription drug tier pricing if you take regular medications.

Step 3: Enter your HSA and tax information. If an HDHP option is available, enter your employer’s HSA contribution, your planned contribution, and your tax bracket. These numbers dramatically affect the comparison.

Step 4: Estimate your healthcare usage. Review last year’s Explanation of Benefits (EOB) statements from your current insurer. How many doctor visits? How many prescriptions? Any procedures or hospitalisations? Use this as the basis for your moderate-use scenario. Adjust upward for the high-use scenario (anticipate a significant medical event) and downward for the low-use scenario.

Step 5: Review the results. The spreadsheet presents total annual cost for each plan under each scenario, highlights the cheapest plan for each scenario, and shows the break-even medical spending level between plans. Make your decision based on the scenario that best reflects your expected year.

Download: Health Insurance Plan Comparison Spreadsheet — Excel (.xlsx)

Plan Type Comparison Table#

Factor	HMO	PPO	HDHP/HSA
Monthly Premium	Low–Moderate	Highest	Lowest
Deductible	Low ($250–$1,000)	Moderate ($500–$2,000)	High (min $1,700 individual / $3,400 family in 2026)
Out-of-Pocket Max	Low–Moderate	Moderate–High	High (max $8,500 individual / $17,000 family in 2026)
PCP Required?	Yes	No	Varies by network type
Referrals for Specialists?	Yes	No	Varies by network type
Out-of-Network Coverage?	Emergency only	Yes (at higher cost)	Varies by network type
HSA Eligible?	Only if HDHP-structured	Only if HDHP-structured	Yes
Best For	Families wanting predictable costs; those comfortable with a single network	People wanting flexibility, specialist access, and willing to pay higher premiums	Healthy individuals/families with savings capacity; those who want tax-advantaged saving

How to Make the Right Choice in 2026#

If You Are Young and Healthy#

The HDHP is almost certainly your best financial option. Your premium savings versus a PPO are likely $1,200–$4,000 per year for a family plan. If you rarely use healthcare beyond preventive care (which is fully covered under all plan types, with no deductible), you keep those savings. Pair the HDHP with maximum HSA contributions, invest the balance, and you build a tax-free medical savings reserve that compounds for decades.

The numbers are clear: for individuals spending less than roughly $3,000–$4,000 per year on healthcare, the HDHP plus HSA tax savings outperforms a PPO in nearly every analysis. The Bogleheads community — a rigorous, numbers-driven investing forum — consistently finds the HDHP wins for most healthy employees when HSA contributions and tax savings are properly modelled.

If You Have Chronic Conditions or Expect a Major Medical Event#

A PPO or HMO typically wins. Chronic conditions requiring regular specialist visits, brand-name medications, and frequent lab work push you toward or beyond the HDHP deductible, eliminating the premium savings advantage. Pregnancy and planned surgery create predictable high-cost years where the PPO’s lower cost-sharing above the deductible saves money.

Run the numbers in the high-use scenario column. If the PPO’s total annual cost is lower than the HDHP’s total annual cost (including HSA tax savings), the PPO is your answer.

If You Have a Family#

Family plan pricing changes the calculus significantly. The HDHP family deductible ($3,400 minimum in 2026) means potentially $3,400+ in out-of-pocket spending before any coverage kicks in. For families with young children who visit the doctor frequently, a PPO’s copay structure can produce lower total costs. However, if your employer makes a generous HSA contribution, the HDHP may still win. This is precisely the scenario where the spreadsheet’s break-even calculator is most valuable.

If You Are Buying ACA Marketplace Coverage#

Check whether you qualify for premium subsidies first — income level determines eligibility, and the subsidy can dramatically reduce your effective premium. Use our ACA subsidy calculator to model how income changes affect your costs. Then compare plans on the Marketplace using this spreadsheet, paying particular attention to the new HSA eligibility for Bronze and Catastrophic plans.

The Long-Term HSA Strategy Most People Miss#

If you are in a position to choose an HDHP, the HSA is not just a medical spending account — it is one of the most powerful long-term wealth-building tools in the tax code. Here is the strategy that maximises its value.

Contribute the maximum every year. For 2026, that is $4,400 individual or $8,750 family. If your employer contributes, your personal contribution closes the gap to the limit.

Pay current medical expenses out of pocket if you can. This is counterintuitive, but the optimal HSA strategy is to pay medical expenses from your regular checking account and let the HSA balance grow tax-free through invested funds. You keep your receipts and can reimburse yourself from the HSA at any point in the future — even decades later. There is no time limit on reimbursement. This allows the HSA to function as a long-term investment vehicle with no required minimum distributions and triple tax advantages.

Invest the balance above your emergency medical cushion. Most HSA providers offer investment options once your cash balance reaches a threshold (typically $1,000–$2,000). Invest the remainder in broad index funds. At a 7% average annual return, $4,400 contributed annually grows to over $90,000 after 15 years — all of it tax-free for medical expenses. After age 65, it can be withdrawn for any purpose (taxed as income, like a traditional IRA, but with no penalty).

This strategy transforms the HDHP from a short-term premium savings play into a long-term wealth advantage. The spreadsheet’s HSA projection section models this growth to help you see the compounding benefit over 5, 10, and 20 years.

For the broader context on comparing any insurance type, see our complete guide to comparing insurance policies in 2026.

Frequently Asked Questions#

When is open enrollment for health insurance in 2026?

For employer-sponsored plans, open enrollment timing varies by employer — typically a two-to-four week window in the autumn. For ACA Marketplace plans, open enrollment runs from November 1 to January 15 (dates may vary by state). Outside open enrollment, you can only change plans with a qualifying life event (marriage, birth, job loss, moving, loss of other coverage).

Can I switch from a PPO to an HDHP mid-year?

Only with a qualifying life event. Otherwise, you must wait until your next open enrollment period. If you switch to an HDHP mid-year, your HSA contribution limit is prorated based on the number of months you are covered by the HDHP, unless you maintain HDHP coverage through December of the following year (the “last-month rule”).

What is the HSA contribution limit for 2026?

$4,400 for individual coverage and $8,750 for family coverage. If you are 55 or older, you can contribute an additional $1,000 as a catch-up contribution. Both employee and employer contributions count toward these limits.

Can I use HSA funds for non-medical expenses?

Yes, but with a penalty. Before age 65, withdrawals for non-qualified expenses are subject to income tax plus a 20% penalty. After age 65, the penalty is removed and non-qualified withdrawals are taxed as ordinary income (similar to a traditional IRA). This makes the HSA a powerful retirement savings vehicle in addition to a medical spending account.

Which is cheaper for a family: HMO or PPO?

It depends entirely on your family’s healthcare usage pattern. HMOs have lower premiums but require PCP coordination and referrals. If your family’s providers are all within an HMO network and you do not mind the referral process, the HMO will be cheaper. If you need specialist access across a broader network, the PPO’s higher premium may be offset by better access and no referral delays. The spreadsheet models both scenarios with your specific plan numbers.

My employer contributes to my HSA. Does that change the comparison?

Significantly. Employer HSA contributions are free money that reduces your effective plan cost. If your employer contributes $1,000 to your HSA with an HDHP, that is $1,000 in plan value that does not appear in the premium comparison. The spreadsheet accounts for this by reducing the HDHP’s net annual cost by the employer contribution amount.

How do I estimate my healthcare usage for next year?

Start with your current year’s claims. Log into your insurance portal and review your Explanation of Benefits statements. Count the number of doctor visits, specialist visits, prescriptions filled, and any procedures. Add up the total amount billed and total amount you paid out of pocket. Use these as your moderate-use estimate. For the low-use scenario, assume only preventive care. For the high-use scenario, add a significant planned or plausible event (a procedure, an ER visit, or a specialist treatment course).

Is there a downside to the HDHP/HSA besides the high deductible?

Yes: cash flow timing. With an HDHP, you may face large bills early in the year before your deductible is met, especially if you have not yet built up your HSA balance. Prescriptions, specialist visits, and lab work all hit at full price until you reach the deductible. If your savings cannot absorb a $1,700–$3,400 expense in the first months of the year, the HDHP’s premium savings may create a budgeting problem even if the annual maths favour it. Some employers offer HSA “front-loading” to address this — ask your benefits team.

Do all three plan types cover preventive care at no cost?

Yes. Under the ACA, all health plans — HMO, PPO, and HDHP — must cover preventive services at no cost to the patient when provided by an in-network provider. This includes annual physicals, vaccinations, cancer screenings, and other preventive services. This applies even if you have not yet met your deductible on an HDHP.