Open enrollment can feel routine, but auto-renewing last year’s plan often leaves money on the table. Premiums shift, deductibles reset, and your care needs change.

With employer costs climbing, a quick annual audit of how you actually use care can trim hundreds—sometimes thousands—without sacrificing protection.

Plan Labels

“High-deductible” doesn’t always mean “high cost.” Many employer high-deductible health plans (HDHPs) pair lower premiums with access to a health savings account (HSA). In practice, an HDHP’s total out-of-pocket after employer contributions can beat a traditional PPO—even when the PPO’s deductible looks lower on paper.

HSA Power

An HSA is a rare triple tax-advantaged account. Contributions go in pre-tax, grow tax-free, and withdrawals for qualified care expenses are tax-free. For the current tax year, you can contribute up to $4,400 (individual) or $8,750 (family), plus a $1,000 catch-up at 55+. Employer HSA dollars count toward those limits—money that lowers your real cost of care.

Why HSAs

HSAs are portable, not “use-it-or-lose-it.” Invest the balance and reimburse yourself years later by keeping receipts. If your employer seeds your HSA each January, that upfront deposit can offset early-year expenses and protect cash flow. Think of it as an emergency fund that also doubles as a stealth retirement medical bucket.

Total-Cost Math

Don’t compare plans by premium alone. Add three numbers: annual payroll premiums, likely out-of-pocket to your deductible, and employer HSA/FSA contributions (subtract these). Model a “low use” year and a “high use” year. The HDHP often wins in low or average years; a richer PPO may shine if you expect significant procedures.

Expert Perspective

Amy Arnott, a portfolio strategist, writes, “In retrospect, I would have been better off signing up for a high-deductible plan and maxing out HSA contributions earlier.”

Use a Calculator

Plug in: payroll deductions, deductibles, copays, coinsurance, expected visits, and employer deposits. Compare plans on guaranteed costs (premiums) plus your realistic variable costs. If you anticipate high ongoing costs, check each plan’s coverage tiers for recurring services—differences there can overwhelm any deductible advantage.

Networks Matter

Before falling for a low premium, confirm your primary doctor, specialists, and preferred hospital are in-network. Out-of-network care can erase savings fast. If a network change knocks out key providers, count the cost of switching doctors or traveling farther for care.

Know the Triggers

HDHPs generally require you to meet the deductible before non-preventive care is covered, but most still cover preventive services at $0. PPOs may offer copays before deductibles. If you have recurring therapies, mental health visits, or specific meds, map exactly how each plan pays for them across the calendar year.

Employer Dollars

Many companies sweeten HDHPs with annual HSA contributions or wellness incentives. Treat those as discounts on your total cost. If your employer adds $500 for individual or $1,000 for family coverage, that can swing the decision—even if the HDHP’s deductible looks intimidating.

Flexible Spending

If you choose a non-HDHP, a healthcare FSA still saves taxes. FSAs reduce taxable income but are generally “use-it-or-lose-it” (with a limited rollover or grace period). If your employer also offers a limited-purpose FSA for dental/vision alongside an HSA, consider stacking those for predictable expenses like glasses or orthodontics.

Outside Options

Compare your partner’s plan. Spousal coverage sometimes offers better networks or lower payroll deductions. If your employer plan meets minimum value standards, you typically won’t qualify for marketplace subsidies—but family members might, depending on income and local rules. Run a quick check on the marketplace before deciding.

Prescription Strategy

Audit your meds. Ask your doctor about generics or therapeutic equivalents in lower tiers. Many plans offer mail-order discounts for 90-day fills. If a specific brand-name drug drives your costs, verify prior authorization rules and whether the plan has accumulator programs that affect manufacturer copay assistance.

Care Habits

Use the right site of care. Telehealth or in-network clinics can be cheaper than urgent care, which is cheaper than emergency rooms for non-emergencies. Schedule preventive screenings—they’re typically covered at $0 and can catch issues early, avoiding bigger bills later.

Decision Flow

Filter out any plan that drops your key doctors or medications. Run total-cost scenarios for each remaining plan. Subtract employer HSA/FSA dollars. Consider your cash cushion when picking deductibles. If costs are close, favor HSA eligibility for long-term tax benefits and portability.

Bottom Line

The cheapest premium isn’t always the best value—and the “richer” plan isn’t always cheaper in practice. Let total-cost math, HSA advantages, and your actual care pattern drive the choice, then commit early so your coverage works smoothly all year.