PlanExpert is the most advanced tool we know of to help you estimate the real "out of wallet" costs of different health insurance plans. But, like any tool, it has its limits and it works better in some circumstances than others. Here's when it works best:
PlanExpert does its best cost predicting when you and your family have routine and predictable medical care needs. For example, you see a mix of primary and specialty care doctors and you know approximately how many visits you make each year. And you use certain prescriptions routinely and you can anticipate which ones you'll use in the next calendar year.
PlanExpert roughly estimates the cost of primary and specialty care. But you can refine those estimates in order to make our cost estimates more accurate. Use your own recollection and billing records to improve upon our crude estimates.
PlanExpert cannot predict if you're going to have costly medical "surprises" like accidents or serious illnesses. That's not the kind of predicting we attempt to do. Generally speaking, a complex illness or a hospitalization will result in your medical expenses triggering your policy's Out of Pocket Maximum.
PlanExpert works better in some states than others. In the fourteen states that don't participate in the national health insurance marketplace, the only publicly available plan data is for the "Silver" level plans. So if you’re from those states, the range of plans that we show and the cost calculations that we perform will be limited and incomplete. Those fourteen states are: California, Colorado, Connecticut, Hawaii, Idaho, Kentucky, Massachusetts, Maryland, Minnesota, New Mexico, Nevada, New York, Oregon, Rhode Island, Vermont, Washington.