initial commit

.gitignore

@@ -0,0 +1,2 @@
+.env
+sbcs/

README.md

@@ -0,0 +1,157 @@
+# Health Insurance Plan Comparison Calculator
+
+A tool to compare health insurance plans and estimate annual costs based on expected medical usage. Try it at **url TK** or run it locally with your own plan data.
+
+The hosted app compares a set of low- and medium-cost plans available in the California ACA marketplace for plan year 2025. To use your own plans, see the instructions below.
+
+## Features
+
+- Compare multiple insurance plans side-by-side
+- Calculate estimated annual costs based on expected medical usage
+- Visualize how costs scale with medical expenses
+- Model emergency scenarios
+- Add and manage your own insurance plans
+
+## Running Locally
+
+1. Clone this repository
+2. Use Poetry to install dependencies: `poetry install`
+3. Modify the `plans.json` file as needed to add or remove plans
+4. Run the app: `poetry run streamlit run app.py`
+
+## Using the Calculator
+
+1. **Add Plans**: Use the "Manage Plans" tab to add plans manually, or modify `plans.json` with your plan details.
+
+2. **Enter Usage**: In the sidebar, enter your expected medical service usage:
+   - Number of primary care visits
+   - Number of specialist visits
+   - Number of urgent care visits
+   - Number of ER visits
+   - Number of lab tests
+   - Number of generic prescriptions
+   - Number of specialty prescriptions
+
+3. **Model Emergencies**: Toggle "Add Emergency Scenario" to model costs for a serious medical event, including:
+   - Ambulance transport
+   - Emergency room visit
+   - Hospital stay (adjustable length)
+   - Follow-up care
+
+4. **Compare Plans**: View side-by-side comparisons of:
+   - Monthly and annual premiums
+   - Estimated out-of-pocket costs
+   - Total annual costs
+   - Cost breakdown by service
+   - Cost scaling visualization
+
+## Plans.json Schema
+
+You can add or modify the `plans.json` file in the same directory as `app.py` using this structure:
+
+```json
+{
+  "plans": [
+    {
+      "plan_name": "String",
+      "plan_type": "String (HMO|PPO|EPO)",
+      "insurer": "String",
+      "premium": "Number (monthly premium)",
+      "deductibles": {
+        "overall": "Number",
+        "family": "Number (optional)"
+      },
+      "out_of_pocket_limit": {
+        "individual": "Number",
+        "family": "Number (optional)"
+      },
+      "referral_needed": "Boolean",
+      "services_covered_before_deductible": [
+        "String (service names)"
+      ],
+      "cost_sharing": {
+        "primary_care": {
+          "in_network": {
+            "copay": "Number (optional)",
+            "coinsurance": "Number (optional, percentage as decimal)"
+          },
+          "out_of_network": {
+            "coverage": "String|Number",
+            "covered_as_in_network": "Boolean (optional)"
+          }
+        },
+        "specialist": { "Same structure as primary_care" },
+        "urgent_care": { "Same structure as primary_care" },
+        "emergency_room": {
+          "care": { "Same structure as primary_care" },
+          "transportation": { "Same structure as primary_care" }
+        },
+        "diagnostic_test": {
+          "lab": { "Same structure as primary_care" }
+        },
+        "prescription_drugs": {
+          "tier_1": {
+            "in_network": {
+              "retail_copay": "Number",
+              "home_delivery_copay": "Number"
+            }
+          },
+          "tier_4": {
+            "in_network": {
+              "retail_coinsurance": "Number (percentage as decimal)",
+              "retail_max": "Number"
+            }
+          }
+        },
+        "hospital_stay": {
+          "facility_fee": { "Same structure as primary_care" }
+        }
+      }
+    }
+  ]
+}
+```
+
+## Calculator Assumptions
+
+The calculator makes several assumptions to model health insurance costs:
+
+### Base Service Costs
+Uses standardized costs for services before insurance:
+- Primary Care Visit: $150
+- Specialist Visit: $250
+- Urgent Care Visit: $200
+- Emergency Room Visit: $1,000
+- Lab Work: $300
+- Generic Drugs: $30/prescription
+- Specialty Drugs: $600/prescription
+- Ambulance: $1,200
+- Hospital Stay: $2,500/day
+
+### Cost Scaling Model
+For the cost curve analysis, medical expenses are distributed across services based on total cost:
+- Low costs (<$1,000): 60% primary care, 40% generic drugs
+- Medium costs ($1,000-$5,000): 30% primary care, 30% specialist, 20% urgent care, 10% lab work, 10% generic drugs
+- High costs (>$5,000): 40% hospital stay, 20% emergency room, 15% specialist, 15% lab work, 10% specialty drugs
+
+### Other Assumptions
+- All services are provided in-network unless specified
+- Prescription drug quantities are per fill/month
+- Emergency services are always covered as in-network
+- Preventive care is covered 100% (as required by ACA)
+- Family plan costs are not currently modeled (uses individual limits)
+- Out-of-pocket maximum includes deductible
+- Copays and coinsurance count toward deductible and out-of-pocket maximum
+
+## Limitations
+
+- Does not model tiered networks
+- Does not account for regional cost variations
+- Does not handle separate drug deductibles
+- Does not model HSA/FSA contributions
+- Does not account for balance billing
+- Does not model coverage limits or prior authorizations
+
+## License
+
+MIT License - feel free to use and modify for your own purposes.