HDHP Vs. PPO Health Plan

I’m going back to the HDHP

I’ll try to max the HSA out and just pay cash for small medical bills. Tax benefits of HSA are awesome over the long run

I never seem to come close to my deductible in my PPO plan and tired of shelling out the health premiums.

Even if you don't contribute periodically to an HSA, you can still contribute after you have pad a bill, then immediately file to get your money back from the HSA, and at least get your out of pocket expenses tax free. If you periodically invest through your employer, it is also exempt from FICA.

You could get a credit card with a zero interest introductory period sufficiently long, charge all out of pocket until the twins get here and maybe beyond, then contribute to the HSA and file immediately to get it back (and pay off the card), and in that manner extract as much benefit as possible from the HSA. The net benefit to you is equivalent to your top marginal Fed and state income tax and FICA multiplied times your actual out of pocket expenses.

I favor HSA, but I never had one until the last two years I worked. I have an HSA/HD ins now because I have seen how health care costs affected my parents in retirement. I pay all medical cost out of pocket and max out the HSA every year, which I will continue to do until I am 65, hoping that I will not have to tap into the HSA until I am 80+.

Sounds to me like you know you're going to hit the 10k OOP next year so it wouldn't make any sense to pay nearly 4k more for that. And this is in a very high expense year for you. The difference alone, even without an employer contribution seems to make the HDHP more affordable that the PPO. Not even thinking about taxes.

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ETA: There’s no scenario where your PPO option ever makes sense over the HDHP.

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Based on the information we have, this is true.

But most ppos will have higher coinsurance where as most hsa plans will either have no coinsurance or a lower amount.

I.e. if he gets a $6000 bill from the hospital. With the hsa he will pay the $4000 deductible, plus coinsurance on the $2000 which may be 0, 50/50, 70/30 etc., which will go to his oop max.

Other the other hand, with the ppo it depends on the policy. He may have a $250 copay for the admission. Then coinsurance of 80/20 on the rest of the bill. Or he may owe the $2500 deductible then 80/20 etc. This could potentially amount to a much lower upfront cost than the hsa.

My point being, we don't really have enough information on the policy to know which could be potentially better deal.

With that said, having twins, with higher risk of nicu stay, certainly would probably risk being at the oop max for either policy, so on the surface the hsa may be the better deal.

It comes down to what the premiums are for each plan.

At my wife's employer, the premiums for the HSA/HDHP are just about the same as the PPO option. But there's a much higher deductible and higher max out of pocket and higher copays. If she doesn't need to use her insurance for that year (pipe dream), the HSA makes more sense for the long term investment strategy. But reality makes the PPO the better option.

At my employer, the HDHP is significantly lower, so I take that option and put plenty of money into the HSA.

Then you have to think about foreseeable costs like you are foreseeing. I will probably join the PPO option in this upcoming enrollment because I foresee some potentially expensive medical situations coming my way, relatively soon.

tl;dr- there's not a right or wrong answer, there are many variables to consider.