Resource from the Center on Budget and Policy Priorities.
We have developed a new tool for in-person consumer assistance staff to use when helping consumers evaluate and select a plan, called the Marketplace Plan Comparison Worksheet.
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 3-5 Bronze and/or Silver plans). This worksheet is intended to help assisters work with clients to note the differences between several plans, and compare and contrast them to 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. This worksheet can help keep track of these details in a user-friendly way and help the consumer walk through the pros and cons of each plan. A consumer can take the worksheet home for further consideration if they are not ready to make a selection.
The worksheet includes fields to compare details on each plan, including:
- the amount of the monthly premium, deductible, out-of-pocket maximum, and co-pays for certain commonly used services such as: primary care physician (PCP) visit, specialist visit, generic drugs, brand name drugs, emergency room visit, and inpatient hospital stay;*
- the amount for co-pays for additional benefits and services that a client would like listed;*
- a client’s particular doctor, hospital, other provider, or medication and whether or not they are included in the network/formulary for each plan (indicate “yes” or “no”); and
- space for “other considerations” in which you can list any other factors or issues a client may want to consider, for example: how many PCPs in network speak Spanish (record the number)? How many OB/Gyns are within 3 miles of the client’s zip code (record the number)? Does the plan include adult dental coverage (indicate “yes” or no”)? etc
* Note: It is also useful to indicate whether this co-pay applies only after the deductible is met, or applies right away even before a deducible has been met.
Also included is a series of questions assisters might find useful in conversation with clients after collecting information on several plans.
Since different plans may be “better” in some categories but “worse” in others, these kinds of questions can potentially help a client figure out their priorities and come to a more informed conclusion on which plan is best for them and their family.
This worksheet includes a box in which an assister can list what plan the client selected, when the coverage starts, what the monthly premium is, and when the first payment must be paid by (if known). We also include a space for an assister to write down the health plan’s customer service phone number. It is often useful for a client to call the health plan a few days later to verify their enrollment, find out when their first payment is due and how to make this payment.