health insurance comparison worksheet
HEALTH INSURANCE COMPARISON WORKSHEET PLAN #1 COST Monthly Premium Co-Pay for Primary Care Co-Pay for Specialist Co-Pay for Urgent Care Co-Pay for Emergency Room Co-Pay for Prescription Drugs Co-Pay for Specialty Drugs Annual Deductible - Individual Annual Deductible - Family Co-Insurance Annual OOP Maximum Lifetime Maximum Best Case Cost Worst Case Cost Probable Cost
CREDITS Tax Credits - Marketplace Plans Discounts - Marketplace Plans TOTAL COST (EXPENSES LESS CREDITS)
PLAN FEATURES Provider Network In-Network Depth Acceptable (Yes/No) Out-of-Network Penalties (No or Partial Reimbursement)
Formulary Prescription Drug Coverage Acceptable (Yes/No)
Preventive Care Coverage (Yes/No) Essential Health Benefits that you’ll need (Yes/No) Dental Care (Yes/No) Vision Care (Yes/No)
PLAN #2
PLAN #3
CREDITS Tax Credits - Marketplace Plans Discounts - Marketplace Plans TOTAL COST (EXPENSES LESS CREDITS)
PLAN FEATURES Provider Network In-Network Depth Acceptable (Yes/No) Out-of-Network Penalties (No or Partial Reimbursement)
Formulary Prescription Drug Coverage Acceptable (Yes/No)
Preventive Care Coverage (Yes/No) Essential Health Benefits that you’ll need (Yes/No) Dental Care (Yes/No) Vision Care (Yes/No)
PLAN #2
PLAN #3
