Resource from the Center on Budget and Policy Priorities. Updated October 2015.
After consumers obtain a tax credit determination, their health plan search tends to narrow down to a handful of plans that fall into a target price range (often three to five plans). This worksheet is intended for assisters to use with consumers to note the differences between several plans, compare and contrast them, and identify which plan best meets their needs.
Overview of the Marketplace Plan Comparison Worksheet
Healthcare.gov and several state Marketplace websites allow you to select multiple plans in a “comparison” feature, or at least click on each plan individually to learn more about the plan’s details. However, these sites often do not allow you to include all aspects of a plan, including information on provider network or formulary. This worksheet allows you to compile these details side-by-side in a user-friendly way to help consumers walk through the pros and cons of each plan.
The worksheet includes fields to compare details on each plan, including:
- The insurance company name, insurance plan name, metal tier of the plan, and plan type (HMO, PPO, POS, etc).
- The insurance plan’s monthly premium (after the tax credit is applied).
- The deductible amount (which is the amount a consumer must pay themselves before the plan begins to start paying for services and the consumer only has to pay the copay or coinsurance). The plan may have separate values for a medical deductible and a drug deductible, or one combined deductible. If it is a family plan, you can note whether it is an aggregate or embedded deductible.
- The out-of-pocket maximum (which is the maximum amount that a consumer would be required to pay in cost-sharing expenses at in-network providers in a given year. Once a consumer reaches this amount, the plan will pay for all other in-network expenses for the rest of the year).
- Copays and coinsurance amounts for commonly used services, such visits to the primary care provider, specialist, emergency room, inpatient hospitalization as well as for filling a prescription for a generic, preferred brand name, non-preferred brand name, or specialty medication. Be sure to note whether or not the deductible applies to that service by checking the corresponding gray box.
- Copay/coinsurance information for up to three more benefits/services based on the consumer’s interests and health care needs in the rows marked “Other service.”
- Whether or not the consumer’s current doctor(s) or preferred hospital or hospital network are in the plan’s network.
- Whether or not the consumer’s prescription medication is covered on the plan’s formulary, and which drug tier it is listed under (generic, preferred brand name, non-preferred brand name, or specialty).
- Other considerations: any other considerations that are important to the consumer, for example, whether or not each plan includes coverage for pediatric dental care or chiropractic services, or how many providers are in network near the consumer’s zip code that speak the consumer’s preferred language, or what the limit is on the number of visits allowed for physical therapy.