Health Insurance Cost Comparison

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).

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.

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.

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.