Standardizes benefit offerings and plan designs of commercial health plans — on or off exchanges — in a comparative database
Easy-to-use, robust database lets you quickly look up copays and coinsurance amounts for all Rx formulary tiers, and link directly to formularies for individual commercial plans by state.
Compare copays, coinsurance, deductibles and out-of-pocket limits for in-network providers — primary care physician (PCP) visits, specialist physician visits, emergency room (ER) visits, inpatient facility admissions
Health plans designing pharmacy benefits for their individual and small business customers can discover the available offerings on public exchanges and look for opportunities to distinguish their own exchange products.
Pharmaceutical manufacturers can gauge how their prescription products appear on formularies, and can determine where out-of-pocket costs and benefit limits create barriers for consumers.
Vendors selling services to health plans can arm themselves with detailed inside information on plan designs and pharmacy benefit offerings in each market.
Insurers that already offer products on public exchanges can evaluate their competition and look for expansion opportunities.
Brokers can help clients (individuals/families, employers/employees) understand their medical and drug benefits, compare health plan options and shop for coverage.
Companies can develop benchmarks to determine benefit trends and create projections about which areas are likely to grow based on plan coverage.
Employers can decide if they need to modify their coverage or introduce new models based on the most current benefit design trends from national market research.
Analysts can calculate average deductibles, out-of-pocket limits and copays/coinsurances to discover trends by geographic area.
Market researchers can make plan-by-plan, tier-by-tier comparisons of coverage and benefits options offered on an exchange.
Users of AIS's Directory of Health Plans can link both databases and perform analyses to discover the exchange plan names and Rx benefit offerings of the insurers they're tracking.
Subscribers of Health Insurance Exchange Database can link both databases to determine the premium rates associated with specific plan design parameters, for a full picture of consumer out-of-pocket costs.
Consumer advocates and providers can track out-of-pocket cost burdens associated with specific plans, insurers and exchanges.
Summary of Benefits and Coverage (SBC) documents that are legally required to be available for all ACA-compliant qualified health plans (QHPs). AIS researchers obtain these documents from insurers and exchanges, examine them and carefully select the relevant data for each field. Additional research is performed to clarify, complete, supplement and rearrange the information into a comparable data format. View the detailed methodology statement on the Demo.