Helping New Yorkers Choose the Right Health Plan: The NYPlanCosts Calculator

Official Title
Health Insurance Marketplace Transparency Calculator: Out-of-Pocket Costs for Specialty Conditions
New York
11/2016 – 11/2018
IMPAQ Health
Policy/Program Analysis
Data Collection & Operations
New York State Health Foundation
Analysis and Validation
In-depth Interviews
Quantitative Data Analysis

Too often the health care system puts patients last, when they should come first. Consumers and patients are frequently marginalized, rather than placed at the center of the health care system and treated as its most important customers. This is especially true for patients with chronic conditions, who often face high out-of-pocket costs associated with high levels of care utilization.

To combat this problem and empower patients, IMPAQ partnered with the New York State Health Foundation and other New York State stakeholders (e.g., New York State Department of Financial Services, New York State of Health Marketplace) to build a New York-specific out-of-pocket cost calculator for high-cost, but relatively common, chronic conditions and life events (e.g., HIV, diabetes). Developed to provide rigorous cost estimates in a user-friendly platform and available to all for free at, the Calculator helps consumers compare health plans and make informed plan selections.

IMPAQ has developed a rigorous methodology that combines plan cost-sharing data and medical/drug pricing information from claims data with specially developed patient treatment scenarios based on nationally- and internationally-recognized clinical guidelines. These estimates then incorporate key patient inputs (e.g., height, age) to provide precise, condition-specific, out-of-pocket cost estimates.

To make the estimates easily accessible to consumers, IMPAQ Health adhered to human-centered design principles to build a website that is easy-to-navigate and mobile-friendly. IMPAQ Health also worked with New York navigators and consumer assisters throughout the development process to ensure the tool is easy for consumers to understand and use.

The NYPlanCosts team combines experts in a variety of disciplines, including data analysts, coders, web developers, pharmacists, health plan experts, and communications specialists. The team brings decades of combined experience in health insurance marketplace policy, qualitative and quantitative data analytics, pharmaceuticals, clinical guideline reviews, and tool development.