13-05: Cost-Effectiveness of Plans (Marketplace) Need to consider premium tax credits and cost-sharing reductions that the individuals may be eligible for when calculating the cost of purchasing a qualified health plan Need to document the methodology used to show it is cost-effective Grantees are encouraged to analyze the formulary, other covered medical benefits, cost of premium, and cost-sharing reductions Grantees do not need to select the most cost-effective plan, but the selected plan must be more cost-effective than if the RWHAP program were to pay for services and medications RWHAP grantees and sub-grantees should inform clients regarding these considerations to assist in enrollment decisions
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