How to Compare HDHP Plans During Open Enrollment

Open enrollment is the primary window during which employees and marketplace participants can select, switch, or waive health coverage. For anyone evaluating a high-deductible health plan, the comparison process involves more variables than premium cost alone — deductible levels, out-of-pocket maximums, HSA compatibility, network structure, and prescription drug tiers all interact to determine actual annual spending. Getting this comparison wrong often means paying thousands of dollars more than necessary.

Definition and scope

Comparing HDHP plans during open enrollment means systematically evaluating two or more high-deductible health plan options — whether offered by an employer, purchased on the ACA marketplace, or available through a union or association — against one another and against non-HDHP alternatives using a standardized set of financial and structural criteria.

The IRS sets the minimum thresholds that define a qualifying HDHP each year. For 2024, the IRS minimum deductible is $1,600 for self-only coverage and $3,200 for family coverage, with out-of-pocket maximums capped at $8,050 and $16,100, respectively (IRS Revenue Procedure 2023-23). Any plan labeled "HDHP" must meet these floor requirements to allow paired Health Savings Account contributions. The full scope of IRS rules governing HDHPs and HSAs shapes which plans qualify and which do not.

The comparison scope extends beyond the plan document itself. Network adequacy, formulary tier placement for regular prescriptions, telehealth cost-sharing, and preventive care coverage — which must be provided at no cost before the deductible under ACA rules (45 CFR § 147.130) — all affect how a plan performs across different usage scenarios.

How it works

Effective HDHP comparison follows a structured, step-by-step process that converts plan documents and Summary of Benefits and Coverage (SBC) forms into projected annual costs.

Step 1 — Gather plan documents
Obtain the SBC for each plan under consideration. Federal law requires insurers and employer plan sponsors to provide SBCs in a standardized format (29 CFR § 2590.715-2715), making direct line-by-line comparison possible.

Step 2 — Record the five core financial parameters
For each plan, capture:
1. Annual premium (employee share, after employer contribution)
2. Deductible (self-only vs. family)
3. Out-of-pocket maximum
4. Coinsurance percentage after the deductible
5. Employer HSA contribution, if any

Step 3 — Model three usage scenarios
Run cost projections under low-utilization (routine preventive visits only), moderate-utilization (one or two specialist visits plus one generic prescription per month), and high-utilization (surgery, hospitalization, or chronic condition management). The real math comparing lower premiums to higher deductibles shows that HDHP premium savings can be entirely offset by deductible exposure at moderate-to-high usage levels.

Step 4 — Account for HSA value
An HSA-eligible HDHP unlocks triple tax advantages: pre-tax contributions, tax-free growth, and tax-free withdrawals for qualified expenses (IRS Publication 969). For 2024, contribution limits are $4,150 (self-only) and $8,300 (family). If an employer seeds the HSA — a common strategy outlined in employer HSA contribution strategies — that contribution directly offsets out-of-pocket exposure and must be factored into the net cost calculation.

Step 5 — Compare network and formulary
Two plans with identical deductibles can produce different costs if one excludes a preferred specialist or places a maintenance medication on Tier 3 rather than Tier 2. Confirm that primary physicians and specialists are in-network, and check the formulary for each regular prescription.

Common scenarios

Scenario A: Two employer-offered HDHPs with different deductible levels
A $1,600 deductible plan with a $180/month employee premium versus a $2,800 deductible plan with a $95/month premium represents a $1,020 annual premium difference. If the employer contributes $500 to the HSA for the higher-deductible plan, the net deductible gap narrows to $780. An individual with no chronic conditions who uses only preventive care — which is covered before the deductible under HDHP preventive care rules — may come out ahead on the higher-deductible option. An individual with one maintenance medication costing $150/month pre-deductible tips the math the other way.

Scenario B: HDHP versus PPO on the same employer platform
This is the most common comparison employees face. A review of HDHP vs. PPO key differences shows that PPOs typically offer lower deductibles and co-pay structures but carry premiums that can run $200–$400/month higher for family coverage. The crossover point — where HDHP total costs equal PPO total costs — usually falls between $3,000 and $6,000 in annual medical spending, depending on plan parameters.

Scenario C: Marketplace HDHP selection
Marketplace shoppers compare plans using metal tier labels, but a Silver plan can qualify as an HDHP while a Bronze plan may not, depending on deductible structure. Income-based premium tax credits (26 U.S.C. § 36B) apply to marketplace plans but not to employer-sponsored coverage, changing the effective premium substantially.

Decision boundaries

Three conditions favor choosing a lower-deductible HDHP over a higher-deductible one even when premiums are similar: anticipated surgery or hospitalization within the plan year, family coverage with pediatric-age dependents who visit specialists regularly, and participation in HDHP chronic condition management programs where pre-deductible cost-sharing applies to maintenance medications.

Three conditions favor the higher-deductible HDHP: strong employer HSA seeding (above $1,000), access to a well-funded HSA from prior years, and a usage pattern limited to preventive care and occasional generic prescriptions.

A plan is disqualifying — regardless of premium attractiveness — if it does not meet the IRS minimum deductible threshold, because enrollment eliminates HSA eligibility for the entire calendar year. Confirming IRS compliance before finalizing enrollment protects the tax benefit that makes HDHPs financially competitive. The comprehensive resources at hdhpauthority.com document these thresholds and their annual updates in detail.

For those uncertain whether an HDHP is appropriate at all, the structured HDHP decision framework provides a systematic evaluation path before open enrollment closes.

References

• IRS Revenue Procedure 2023-23 — 2024 HDHP and HSA Thresholds
• IRS Publication 969 — Health Savings Accounts and Other Tax-Favored Health Plans
• eCFR 45 CFR § 147.130 — Required Coverage of Preventive Health Services
• eCFR 29 CFR § 2590.715-2715 — Summary of Benefits and Coverage Requirements
• 26 U.S.C. § 36B — Premium Tax Credit (U.S. House Office of the Law Revision Counsel)
• CMS — Summary of Benefits and Coverage Overview

The law belongs to the people. Georgia v. Public.Resource.Org, 590 U.S. (2020)