The Paycheck Series ยท 10 min read
Open Enrollment, Decoded
HDHP versus PPO is arithmetic, not instinct
Reviewed by Jonathan Shafer, DO, July 2026. Disclosure: the reviewer is the founder and owner of Attending Financial LLC. This is education, not individualized financial advice.
Four minutes in November, $6,000 on the table
Every November, a benefits portal gives you a countdown clock and a wall of acronyms, and most physicians resolve the whole thing in about four minutes: pick the PPO, because the deductible is smaller and the year is busy. That reflex has a price. For a physician family at a 32 to 35 percent marginal federal rate, choosing between a PPO and an -qualified high-deductible plan is routinely a $4,000 to $7,000 annual decision โ before anyone gets sick. The premium line you see in the portal is only one of four numbers that matter. The others โ the premium gap across twelve months, the employer HSA seed, and the tax value of an $8,750 family HSA contribution โ never appear on the comparison screen. This module walks the full arithmetic for 2026: what legally counts as a high-deductible health plan, how to run a total-cost comparison instead of a premium comparison, and what changed for physicians who buy their own coverage now that the marketplace subsidy cliff has returned. Ten minutes here is a defensible trade for a decision you will repeat every year of your career.
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- Premiums are the sticker price, not the cost
- One family, two plans, the full arithmetic
- Buying your own coverage after the cliff came back
- Check yourself before you click enroll
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