On a gray Saturday in January I finally opened the folder Greg's HR sent home in November and checked whether we'd picked right. We chose our 2026 health plan during his open enrollment, and I want to write down how we thought about it while January's snow is still on the porch rail.
This was our first open enrollment as two people with no kids on the plan. Greg is 58, I'm 55 for a couple more weeks, and if you looked at our claims you'd think we were made of oak. Last year we each had a physical and bloodwork, Greg had one visit for his left knee, and I had my $9-a-month generic. That's about it.
The two plans on the table
Greg's employer offered two choices for employee plus spouse. I'm leaving out the insurer name because yours will be different anyway.
The PPO. $296 a month for us, plus the $100 spousal surcharge we already pay. A $1,500 per-person deductible, $3,000 for the family. Copays for office visits. Out-of-pocket maximum of $6,500 per person, $13,000 for the family.
The high-deductible plan with a health savings account. $196 a month, plus the same $100 surcharge. A $3,400 family deductible that must be met before the plan pays for most things other than preventive care. Out-of-pocket maximum of $7,500 for the family. Greg's employer puts $1,000 a year into the HSA.
What an HSA is, in plain words
A health savings account is a savings account for medical costs with triple tax perks. Money goes in before tax, grows without tax, and comes out without tax if you spend it on qualified medical expenses. Unlike a flexible spending account, it doesn't expire at year's end. It's yours to keep, even if you change jobs.
The rule is that you can only put money into an HSA if you're covered by a qualifying high-deductible plan and no other non-qualifying health coverage. For 2026 the limit for family coverage is $8,750 a year, including the employer's part. People 55 and older can add $1,000 more as a catch-up. Here's the wrinkle I learned: each spouse's catch-up has to go into an account in that spouse's own name. So since we're both over 55, I'll open my own HSA to hold my $1,000, and Greg's account gets his.
One more thing to remember for later: once you're enrolled in Medicare, you can't put new money in an HSA anymore. Greg plans to work until about 64, so that's not a near-term problem, but I wrote it in the notebook.
What we expect to actually use
I went back through two years of statements and made my best guess for 2026. Two physicals, which are free on either plan. Two rounds of bloodwork. One or two visits for Greg's knee, maybe an X-ray. My generic prescription. Call it $1,200 to $1,500 in total billed care in a normal year.
Here's how the two plans compare for us in three kinds of years:
- Quiet year ($1,300 in care): PPO premiums $3,552, plus about $300 in copays, so about $3,850. HSA plan premiums $2,352, plus $1,300 in care, minus the $1,000 employer deposit, so about $2,650.
- Medium year ($5,000 in care): PPO about $3,552 plus roughly $2,800 out of pocket, about $6,350. HSA plan about $2,352 plus about $3,700 out of pocket, minus $1,000, so about $5,050.
- Bad year: PPO up to $3,552 plus $13,000. HSA plan $2,352 plus $7,500, minus $1,000. The HSA plan still comes out ahead, because its family maximum is lower than the PPO's two-person maximum.
Those numbers leave out the surcharge, since it's the same on both. They also leave out the tax savings on what we put in ourselves, which makes the HSA plan look even better.
What we picked and how January's going
We chose the high-deductible plan. The premium difference alone is $1,200 a year, and the employer's deposit makes it $2,200. We set up payroll contributions so that, with the employer's money, Greg's account gets the family maximum spread over the year, plus his catch-up. My catch-up comes from our checking account into my own HSA.
The part I had to make peace with is paying full price for that knee visit before the deductible is met. In January that feels bad. But the money we're not spending on premiums is sitting in the HSA, so we're paying the bill with tax-free dollars we set aside for exactly that.
Greg's only question was whether the HSA has a debit card. It does. He's already asked if it covers Biscuit's vet bills. It does not.
I'm not a benefits expert, and a high-deductible plan isn't right for everyone. If you have a chronic condition, regular specialists, or no cushion to cover the deductible, the PPO may well be the better deal. For two people who barely see the doctor, this was the plan that fit what we actually do.
