HDHP vs PPO plan with known high health costs

Hi All, I've searched the sub and found the comparison worksheet on the wiki, but I'm still coming up with questions. I have found several mentions that an HDHP can be good for those with very high medical costs, but I can't find examples to clarify why.

I have always done the PPO plan, because I have MS and my annual medical bills (before the negotiated rate) are usually upwards of $200k. But the tax advantage of the HSA is alluring to me and I'm wondering if it may be worth it to spend more now to save the taxes.

Here is where I'm confused. The prevailing wisdom seems to be that with very high costs, you'll hit the OOP Max regardless. But I don't with my PPO plan because all I pay for a specialist office visit is the $30 Copay. And for some bizarre reason, the only portion of my $100,000 infusion that hits my deductible is $379.

As near as I can tell, I will spend about:

$5500 on Healthcare with the PPO plan. Premiums + Copays + FSA contributions – tax savings. Even if I had a catastrophic event and did hit the OOP max, it would come to $10k total.

$17K on Healthcare with the HDHP. Premiums + OOP Max + $8k in the HSA – tax savings.

I assume I WILL hit the OOP max with the HDHP because the coinsurance won't cover most of my infusions. It covers 80% of the allowable amount once I hit the deductible.

But of course I'm double counting my costs a bit with the HDHP, because I'm assuming I will cash flow the bills and let the $8k sit in my HSA until I'm disabled or retire.

The other wrinkle is that if I can get my first infusion early in the year, (like January), the Copay Assistance program from the drug manufacturer will pay enough that I'll hit my deductible early in the year and then only pay 20% coinsurance which means I may NOT hit the OOP max.

So, can anyone help me think through whether it's worth spending $17k vs $5500 a year just for the privilege of $8k in tax advantaged savings? What else to consider?

It would be a hardship in the budget for sure, likely reducing what I can save for retirement in my taxable brokerage, and likely no vacation or fun money. (I could still max my 401k and Roth).

But will it be worth it if I am unable to work at 50 and need healthcare dollars to spend? (I realize if I'm truly disabled and on SSDI, I could get Medicare, but with MS it's hard to prove disability even when you truly can't work).

Happy to share more numbers if needed.

ETA, per automod: late 40s, Minnesota, pretax HH income $185k. (Note: all costs listed above, including HSA contributions are for both me an my husband. He has less complex needs but is nearly 60 so who knows what the future holds)

submitted by /u/nostalgicvintage
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