Two plans, one year of care

Published 2026-09-20 · Last reviewed 2026-09-23

A health plan does not have a price; it has a schedule. The premium is paid whether or not you use care, the deductible is what you pay first, the coinsurance is your share of everything above it, and the out-of-pocket maximum is where your own spending stops. The only honest way to compare two plans is to run them against the same year of bills and add premium and care together. This page does exactly that, and it surfaces the number that actually decides the choice - the level of medical spending at which the two plans cost the same.

The real annual cost, both plans

Take two self-only plans. The first is a high-deductible plan at $250 a month with a $1,700 deductible, 30 percent coinsurance and an $8,500 cap. The second costs $500 a month with a $500 deductible, 20 percent coinsurance and a $5,000 cap. Against a year of $2,000 in covered care, the high-deductible plan costs $4,790; the low-deductible plan costs $6,800. The premium difference alone is $3,000 a year; the question is which one the care bill tips.

The two lines cross at $22,100 of medical spending. Under that, the high-deductible plan wins because the premium saving is banked; above it, the low-deductible plan wins because it starts paying sooner and its cap arrives earlier. So the answer is not "which plan is better" but "which side of $22,100do you expect your year to land on" - and how much cash you could produce if a bad year arrived in January.

The order matters as much as the numbers. A plan is not just a deductible; 30 percent coinsurance past a $1,700 deductible reaches a very different total than 20 percent, and an $8,500 cap stops your losses far higher than a smaller one. Two plans can share a deductible and still differ by thousands in the year you actually get ill, which is why comparing on the deductible alone is how people end up paying more.

The health savings account changes the column

The high-deductible plan in this example qualifies for a health savings account - the check is confirmed by the engine against the 2026 definition of at least $1,700 deductible and no more than $8,500out of pocket for self-only cover. That qualification matters, because the account is where a high-deductible plan earns its keep: contributions are pre-tax up to $4,400 a year (plus $1,000 from age 55), growth is untaxed, and withdrawals for qualified medical expenses are untaxed as well. The comparison above deliberately ignores that saving, so the high-deductible column is better than it looks, not worse.

The order of play is also worth stating: the deductible counts toward the out-of-pocket maximum, so a $1,700 deductible inside the $8,500 cap leaves a known amount of coinsurance and copays before your spending stops. Paying qualified expenses from the account is tax-free at any age; the stronger play, if cash flow allows, is to pay current bills from ordinary money and leave the account invested, because the receipts never expire and the balance compounds untaxed meanwhile.

Where these numbers come from

• Every figure follows the same health-plan rules. The premium, deductible, coinsurance and cap are applied in the order the plan applies them, using the same calculation the calculator runs, so this page prints exactly what the tool would.
• The HSA limits are the 2026 published amounts. $4,400 self-only and $8,750 family contributions, a $1,000 catch-up from age 55, a $1,700 or $3,400 minimum deductible and $8,500 or $17,000maximum out of pocket - taken from IRS Rev. Proc. 2025-19.
• What was deliberately left out. Out-of-network care, balance billing, drug tiers, dental and vision, and the tax treatment of the premium itself - plus the premium tax credit on Marketplace plans, which is a separate calculator's job.

What this guide does not cover

It is not a recommendation for a specific insurer, and it cannot know which plan your employer or marketplace actually offers, whether your regular doctor is in network, or what your prescriptions cost under either tier. It also does not price preventive care, which ACA-compliant plans cover without cost sharing and which makes a pure premium-plus-deductible model slightly pessimistic; and it says nothing about the premium tax credit that changes what Marketplace buyers actually pay. Run your own two plans against your own expected use, and treat the break-even spending level as the line between a plan that saves you money and one that costs it.

Compare your own plans in the Deductible Calculator, see what a Marketplace subsidy does to the premium in the ACA Subsidy Calculator, see where your own spending stops in the Out-of-Pocket Maximum Calculator, or see the net effect on pay in the Paycheck Calculator.

Estimates only - not medical, financial, tax or legal advice. Read the full disclaimer.