Marketplace plans

Every individual-market and small-business (SHOP) health plan and stand-alone dental plan sold on the federal marketplace, one record per plan: who offers it, its metal level and network type, where it is sold, its monthly premiums by age and rating area, and each cost-sharing variant's deductibles, out-of-pocket maximums and benefits, as CMS publishes them. Facts and links only: the issuer's own explanations and exclusion notes are never stored, and benefits are named by CMS's categories, never by CPT or CDT codes.

Find plans sold in a county, then look one up:

curl "https://api.healthcare.dev/v1/marketplace/plans?county=48453&metal=silver" \
  -H "Authorization: Bearer $HDEV_API_KEY"
curl "https://api.healthcare.dev/v1/marketplace/plans/29418TX0140108?rating_area=1&age=40" \
  -H "Authorization: Bearer $HDEV_API_KEY"

An illustrative response (the shape is exact; the values are from the plan year 2026 files, trimmed):

{
  "data": {
    "id": "29418TX0140108",
    "plan_year": 2026,
    "name": "Standard Silver",
    "issuer": { "id": "29418", "name": "Ambetter from Superior HealthPlan" },
    "state": "TX",
    "market": "individual",
    "dental_only": false,
    "metal_level": "silver",
    "plan_type": "EPO",
    "exchange": "on_and_off",
    "service_area": {
      "id": "TXS001",
      "name": "Superior Health Plan 1",
      "covers_entire_state": false,
      "counties": [{ "fips": "48453", "partial": false, "zip_codes": [] }]
    },
    "rating_areas": ["Rating Area 1", "Rating Area 2"],
    "cost_sharing": { "variant_id": "29418TX0140108-01", "deductible": 6000, "moop": 8900 },
    "premiums": [
      {
        "rating_area": "Rating Area 1",
        "effective_date": "2026-01-01",
        "expiration_date": "2026-12-31",
        "tobacco_rated": true,
        "rates": [{ "age": "40", "individual": 893.55, "individual_tobacco": 1027.58 }],
        "family": null
      }
    ],
    "variants": [
      {
        "id": "29418TX0140108-01",
        "csr_variation": "Standard Silver On Exchange Plan",
        "deductibles": {
          "medical": null,
          "drug": null,
          "combined": {
            "in_network": {
              "individual": 6000,
              "family_per_person": 6000,
              "family_per_group": 12000
            },
            "in_network_tier2": null,
            "out_of_network": null,
            "combined_in_out_of_network": null
          }
        },
        "benefits": [
          {
            "name": "Accidental Dental",
            "covered": true,
            "ehb": true,
            "copay": {
              "in_network": "Not Applicable",
              "in_network_tier2": null,
              "out_of_network": "Not Applicable"
            },
            "coinsurance": {
              "in_network": "40.00% Coinsurance after deductible",
              "in_network_tier2": null,
              "out_of_network": "100.00%"
            },
            "limit": null,
            "excluded_from_moop": { "in_network": false, "out_of_network": true }
          }
        ]
      }
    ],
    "links": {
      "summary_of_benefits_url": "https://api.centene.com/SBC/2026/29418TX0140108-01.pdf"
    }
  }
}

Finding plansCopy Anchor Link

GET /v1/marketplace/plans lists plans by id with their headline facts (no premiums or variants). Filters:

A county in a partly covered service area (partial: true) is covered only in the ZIP codes the plan lists; check zip_codes on the plan.

One planCopy Anchor Link

GET /v1/marketplace/plans/{plan_id} takes the 14-character plan id; a variant id (29418TX0140108-01) finds its plan. Plan ids are the issuer's HIOS ids: a plan that carries over keeps its id from one plan year to the next, but plans come and go each year.

• Premiums are the monthly base rates as published, per rating area and rate period (small business plans can have quarterly rates), by age: 0-14 (one rate for every child), 15 to 63, and 64 and over. They are before any premium tax credit. individual_tobacco is the tobacco user's rate where the plan rates tobacco use. A few plans (family) are rated by family size instead of age. CMS writes 9999 for an age a plan isn't offered at; we serve null. rating_area (1 or Rating Area 1) and age narrow the list. Which rating area a county is in is set by each state; the files don't say.
• cost_sharing is the standard variant's individual in-network deductible and out-of-pocket maximum (-01 on the exchange, else -00), the combined medical and drug amount when the plan integrates them. Every variant's amounts are in variants.
• Variants: -00 off the exchange, -01 on it, and silver plans' cost-sharing reductions (-04 to -06 for 73%, 87% and 94% actuarial value; -02 and -03 for American Indians and Alaska Natives). Each has deductibles and moop (maximum out of pocket) for medical, drug or combined benefits, per network tier, and its benefits: copay and coinsurance per tier as published ($40 Copay after deductible), quantity limits, and whether the cost sharing counts toward the out-of-pocket maximum.
• Links go to the issuer's own pages: formulary, brochure, summary of benefits and coverage, and payment. Provider networks and drug lists are the issuer's; follow its links.

ViewsCopy Anchor Link

What to show your usersCopy Anchor Link

Show where the data comes from and that it isn't the final word: "Derived from the CMS Health Insurance Exchange public use files for the plan year; not CMS data, and it may differ from what HealthCare.gov shows." Premiums are before any subsidy, and what a person pays depends on their household; send them to HealthCare.gov or the issuer to enroll. The API's meta.license_terms carries the wording.

Not in this datasetCopy Anchor Link

• States running their own exchange platform (CMS publishes their plans separately).
• Provider networks and formularies: issuers publish them as their own files; we link to them.
• Medicare Advantage, Medicaid and employer plans.