The Three Plans at a Glance
KC typically offers three tiers of healthcare coverage during open enrollment. Premium and deductible amounts vary — use these as a framework, and pull your actual plan documents for exact figures.
| HDHP + HSA | PPO Standard | PPO Premium | |
|---|---|---|---|
| Monthly premium (est. employee-only) | Lowest (~$90/mo) | Mid (~$220/mo) | Highest (~$320/mo) |
| Annual deductible (individual) | $1,600+ | $500–$1,000 | $250–$500 |
| Out-of-pocket maximum | $4,000–$6,000 | $3,000–$5,000 | $2,000–$3,500 |
| HSA eligible? | Yes | No | No |
| Best for | Healthy, low utilizers who want tax savings | Moderate healthcare users | High utilizers, chronic conditions, families |
Premium and deductible estimates are approximate. Always verify against your current KC benefits summary plan description.
The HDHP Break-Even Calculation
The HDHP's lower premium is appealing, but you need to clear a higher deductible before insurance kicks in for most services. Here's how to figure out whether the savings are real for you:
Annual premium savings (HDHP vs. PPO) > Expected out-of-pocket costs difference
If you'd save $1,560/year in premiums but expect to spend $2,000 more out-of-pocket, the PPO is cheaper. If you'd spend less than $1,560 out-of-pocket before hitting your deductible, the HDHP wins.
To estimate your expected out-of-pocket costs, look at your explanation of benefits (EOB) statements from last year. Add up what you actually paid for doctor visits, prescriptions, labs, and any procedures — that's your baseline.
The HSA: The HDHP's Hidden Advantage
The Health Savings Account (HSA) is what makes the HDHP genuinely powerful for the right person. HSAs have a triple tax advantage that no other account type matches:
- Contributions go in pre-tax (or are tax-deductible if contributed directly)
- Money grows tax-free
- Withdrawals for qualified medical expenses are tax-free
2025 HSA contribution limits:
- Individual coverage: $4,300
- Family coverage: $8,550
- Catch-up (age 55+): Additional $1,000
Who Should Choose the HDHP?
The HDHP + HSA is a strong choice if:
- You and your family are generally healthy with few regular prescriptions or specialist visits
- You have an emergency fund that could cover the deductible if needed
- You want to build long-term tax-advantaged savings
- You're earlier in your career and in a lower tax bracket
Who Should Stick with the PPO?
The PPO (Standard or Premium) makes more sense if:
- You or a family member has a chronic condition requiring regular care
- You expect significant healthcare utilization (surgeries, ongoing therapy, specialist visits)
- You take expensive brand-name medications regularly
- You don't have savings to cover a high deductible if something unexpected happens
- You're pregnant or planning to be — prenatal care and delivery costs add up fast
The Most Common Mistake: Choosing by Premium Alone
Many KC employees pick the cheapest monthly premium without doing the break-even math. A $1,560/year premium savings sounds great — until you have an unexpected ER visit or a family member needs physical therapy. The "cheapest" plan can become the most expensive one if your actual usage is high.
The reverse is also true: paying for a Premium PPO when you're young and healthy and rarely see a doctor is money left on the table.
Making the Switch During Open Enrollment
A few things to check before changing plans:
- In-network providers: Verify your doctors and specialists are in-network under the new plan. Networks can differ even within the same insurance carrier.
- Prescription coverage: Check your specific medications under the new plan's formulary. Tier placement affects cost significantly.
- HSA balance portability: If you're leaving an HDHP and have an HSA balance, those funds remain yours forever and can be used for future qualified medical expenses.
- FSA grace period: If you're switching away from a PPO with a Flexible Spending Account (FSA), use up your FSA balance before year-end — most FSAs have use-it-or-lose-it rules.