How Your Plan Score is Calculated

Overview

Our plan advisory tool uses decision support capabilities from Picwell to help you choose a plan. The tool asks a few simple questions and uses your answers to evaluate the suitability of each plan. All eligible plans are evaluated and assigned a score between 0 and 100, with higher scores indicating greater suitability.

Consumer Inputs

The tool uses age, gender, ZIP code, prescription drugs, and information regarding any preferred doctors you currently see.

Scoring and Ranking Process

The suitability of a plan is measured by the score, which is an indication of how well a plan matches your needs. The score is based on:

• Total estimated costs for "people like you" under this plan.
• How well this plan protects "people like you" against unexpected out-of-pocket expenses.
• Whether or not your preferred doctors are covered by the plan and how strongly you feel about having those doctors in your plan's network.
• The relevance of plan quality and performance ratings for "people like you" as measured by CMS Star Ratings (where applicable).

The score summarizes the above factors into a single number between 0 and 100 for each plan. It allows you to compare plan options on an "apples­-to-­apples" basis across plans in your area. Plans with higher scores are more suitable for "people like you."

Notes

In addition to the score, information on why a plan is more suitable for "people like you" is displayed. This helps you understand which factors drive greater suitability for a plan, relative to other plans in your area.

The score considers distinct CMS Star Ratings for health and drug services instead of the overall CMS Star Rating displayed, and weights them according to how "people like you" use their plans.

Total Estimated Costs

Total estimated costs account for premiums and estimated out-of-pocket expenses across health services and prescription drugs. It shows the likely range of total spending under a plan, since monthly premium isn’t the only financial metric to be considered when choosing a plan.

Disclaimer

• Total estimated costs are based on the health spending of "people like you"; your actual health spending may be higher or lower depending on your use of health services.
• The score does not account for additional factors that may be important to you when choosing a plan (for example, additional benefits provided by the carrier).