The premiums are much lower for HSAs. In a lot of cases, even if you hit that max out of pocket, you end up spending less than you would with a traditional plan over the course of the year. Many people do not ever come close to that max out of pocket, or if they do, it is generally a one-two year timetable. I'll admit it does require more effort to manage. As for expense, I chose to sock away the difference between my old insurance premium and my new premium in the HSA which was about $40 a week. There was no change in my take home pay, except that I had that $40 a week that was going into an account for me to use on my medical expenses. It earns interest, and if God willing, I'm healthy until retirement, I can withdraw what I put in as income just like a 401(k) or IRA. I call that a win.