I have had both. My benefits come from my wife. There are pros and cons to both.

If you are young and single it is a no brainer. If you don't need an prescription drugs, especially non-generics, its a no brainer. I'm also going to go out on a limb here and say maybe depending on where you live it makes sense due to probably lower costs of medical care. There are many aspects though that need to be looked at if you are more then a young single person. Premium differences between a standard PPO vs HSA. Deductible amounts of both, Coinsurance of both, Out of pocket max, etc.

We are a family of 4. The first time I was exposed to an HSA option was like 4 or 5 years ago. Back then when I was comparing plans it "seemed" like the difference in premiums of an PPO vs HSA was paying up front in a PPO plan vs. putting the difference in my pocket. We typically went for routine preventative physicals and then I accounted for the typical other visits we might make during a year. Allergist, kids sick, etc. With an HSA, I would bee well ahead of the game with $$ in my pocket. We also elected to sock away the max allowable amount into the account. My thinking was if we go 2 years with normal Dr. visits etc then we would have more then enough $$ put away in the HSA to being fully covered for the worst case scenario of 2+ people needing serious medical care within the same year (out of pocket max). With an HSA, since its your own $$, you tend to be more vigilant with running to the Dr. A child gets a cold, you wait several days vs running to the Dr, under a PPO, since its only a $15 or $20 copay. But, there is a balance that needs to be struck since you can find yourself ignoring things, which should be looked at, for the sake of not wanting to spend the $$ growing in your acct.

So... Shit happens.

That first year of our HSA, my daughter sprained her wrist, which ate up a nice sum (Hospital, X-rays, Durable Medical equip, etc). Luckily it was while at camp and a more rural area with much cheaper medical costs. Then she fractured it. So... More X-rays, hospital visits, durable medical equip, and now back to Dr's in my neck of the woods with high rates. An pediatric orthopedist, more scans, waterproof cast etc. Well, that blew through a huge chunk of the dollars right there in the 1st year. This is also where I became exposed to the dark secret of medical care that there is no way to know what stuff costs. No real way to "shop" around on most things. Call a Dr. to ask what the costs will be for a given procedure and like 99% of the time they can't tell you. For one they don't handle the billing and many times they don't know "your" costs until bills are submitted to insurance. Call the insurance Co and get the same run around. Depends on the order of codes submitted, etc. It's complete BS. Prior to HSA's you never really had exposure. My wife had switched jobs after that HSA year and then we were back to only a PPO option. This time, it wasn't just co-pays. There was a co-insurance component (80/20) for things like hospital visits, out patient procedures, now diagnostics like X-rays, MRI's, etc. So, still have the frustration of trying to make educated medical decisions on things but no way to really know up front what something might cost. Some things are online, like MRI costs and I can see one provider charge $1,400 vs another non-hospital affiliated center at $400. So, I can shop around. But, a Dr. orders a diagnostic test to monitor a certain function and we are back into the abyss of trying to ascertain what this procedure costs and is it possible to do it cheaper through a different trusted provider, who is in-network.

There are also pro's and cons with FSA vs HSA Spending accounts as well. The FSA is use it or loose it vs the HSA which just rolls over each year. HSA's "typically" allow more $$ to be put in the acct vs FSA in a calendar year. I say "typically", since the amount is capped by what you employer will allow. With an FSA you get access to your election on day 1 vs. an HSA which accrues over the 12 months. For example, if you put 3K into an FSA, your contributions are taken out each pay period over the 12 months, but you get access to that 3K on Jan 1. With an HSA, you only get access to the funds at that are currently contributed into the acct at the time you need them. So, if you knew you needed an expensive medical procedure, you can get access to the funds right away in an FSA to pay vs. possibly having to pay out of pocket, under and HSA, and then get reimbursed throughout the year as your contributions hit your HSA account. The latter is what happened to me under the scenario above, when I was under the HSA with my daughters injuries. While an FSA is use it or loose it, the flip side is that if you left you job or got fired you are not on the hook for repayment. Thus, if you had a procedure on Jan 30th, in which you used your entire 3K balance in your FSA account but only contributed $250.00 thus far, then left your employer shortly after, then you don't have to re-pay those funds. I have been here too. A couple of times. This is why employers cap what you are allowed to put in to minimize exposure. Although I don't think the employer takes a hit unless its large and is self funded. Its the company that runs the FSA component. On the flip side, they keep the $$ forfeited that weren't spent within the cal year. An HSA also can charge maintenance fee's, which eat into your balance. Depends on the plan and your employer. We had no fee's when employed but when my wife switched jobs we then started getting assessed annual maintenance fee's.

I am in the middle of doing this again, since we are in open enrollment and have an HSA option. Probably not going that route, given the past and present medical needs in the family. Plus, what is being offered is a head scratcher compared to PPO.