Open enrollment: HDHP vs PPO with new spouse

Much appreciate any input.

My sister recently wed, with the husband added to her employer plan. She had always been on the HDHP, but now with a spouse and open enrollment, we're trying to see if it makes sense to go with the PPO. She's anticipating significant expenses next year, all in-network, while her husband has historically required minimal care. Both the HDHP and PPO share the same Anthem Blue Cross network.

HDHP PPO HSA $2,000 by employer NA Premium (annual) $2,840 $4,020 Deductible $3,200 per family $400 per individual/$800 per family Out-of-pocket maximum $5,200 per family $2,000 per individual/$5,000 per family Emergency You pay 10%, after the plan deductible is met $250 Copay and then 10%, waived if admitted, after deductible is met Inpatient Hospital You pay 10%, after the plan deductible is met You pay 10% after deductible is met Primary/OBGYN co-pay You pay 10%, after the plan deductible is met $20 Specialist/urgent co-pay You pay 10%, after the plan deductible is met $30

HDHP: $2840 premium + $5200 OOP – $2000 HSA employer contribution = $6040 max cost

PPO: $4020 premium + $2000/4000 OOP = $6020/$8020

Sister has historically not added further to her HSA beyond the employer $2000, but anticipating expenses, we're thinking of contributing at least $1200 to cover the $3200 deductible.

Assuming her planned expenses are in-network, it still seems to make sense to go with the HDHP. Thoughts appreciated!

submitted by /u/mcnullt
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