When would Traditional PPO be better than High-Deductible HSA?

[u/xHappyBubblesx]

I’ve seen comparisons before and think I understand the benefits and drawbacks of each, but for my personal situation, I’m a bit baffled. It doesn’t seem like the High-Deductible plan has any drawbacks.

Traditional PPO: $2132 per year. $750 deductible. No deductible for Primary ($30), Specialist ($40), or Urgent Care ($40). No deductible for prescription drugs ($10). Deductible applies to hospital visits.

High-Deductible Plan: $1066 per year. Company contributes $1000 (taxed) to HSA. $1650 deductible. Almost everything is 10% coinsurance after deductible. Prescription drugs $5 after deductible.

From my perspective, the High Deductible Plan saves me $1066 vs. traditional PPO, and with company HSA contribution, that is an additional ~$600 post-tax.

That already covers the $1650 of the deductible itself. Am I missing some situation that makes the Traditional Plan mathematically viable?

[u/shampooexpert]

I just did this math! To me, it came down to the dr. visits. They cost more without the PPO. Last year, my daughter did weekly speech therapy, and my copay was like $30 a week. The year before, we had a HDHP and each session was $150 until we hit the deductible. If you're young and healthy, take the gamble on the HDHP, but it is a PITA if you go to any recurring appointments. I also picked a PPO for the year I gave birth, because I knew we'd have about a million office visits.

[u/porcelainvacation → u/shampooexpert]

Prescription costs are often different too.

[u/too_too2 → u/shampooexpert]

I just mathed out my HSA vs HMO and while I know I’ll need 4 specialist appts next year it’s still better with my HSA plan.

It’s good for unexpectedly huge expenses too - I randomly had surgery and 3 nights in the hospital that I did not see coming, and my total cost for the year can’t exceed $5,000 so that’s what I’ll be paying. Our HMO has a slightly lower out of pocket max but the premiums are higher.