# Marketplace plans URL: https://docs.healthcare.dev/datasets/marketplace-plans | | | | --------------- | --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- | | Source | CMS [Health Insurance Exchange public use files](https://www.cms.gov/marketplace/resources/data/public-use-files) for the plan year: Plan Attributes, Benefits and Cost Sharing, Rate and Service Area | | Source id | `cms-exchange-puf` | | Coverage | The states on the federal platform (HealthCare.gov, including state exchanges that use it): 30 states for plan year 2026. Not states running their own exchange platform (such as California or New York) | | Release cadence | One plan year a year (CMS posts it in late July or August, ahead of open enrollment), corrected in place now and then; we check the files weekly and publish a new version when one changes | | License | Public domain (US government work). Our records are derived from the CMS files, not CMS data, and may differ from what HealthCare.gov shows | | Plans | Pro and Team (`403` `plan-upgrade-required` below; Free and Builder get a few preview calls a month) | | Endpoints | [`/v1/marketplace/plans`](/reference/marketplace/aca-marketplace-plans), [`/v1/marketplace/plans/{plan_id}`](/reference/marketplace/one-aca-marketplace-plan) | 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: ```sh 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): ```json { "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 plans `GET /v1/marketplace/plans` lists plans by id with their headline facts (no premiums or variants). Filters: | Filter | What it does | | ----------- | -------------------------------------------------------------------------------------------------------------------------------------- | | `state` | Two-letter state | | `county` | County FIPS code (5 digits, e.g. `48453` for Travis County, TX): plans whose service area covers all or part of it, or the whole state | | `metal` | `bronze`, `expanded_bronze`, `silver`, `gold`, `platinum`, `catastrophic`; dental plans are `high` or `low` | | `plan_type` | `HMO`, `PPO`, `EPO`, `POS` or `Indemnity` | | `market` | `individual` or `shop` (small business) | | `dental` | `true` for stand-alone dental plans only, `false` for medical plans only | | `issuer` | HIOS issuer id (the first 5 digits of a plan id) | 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 plan `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. ## Views | View | List fields | Plan fields | | -------------------- | ------------------------------------------------------------------ | ------------------------------------------------------------------------------------------------ | | `compact` | `id`, `name`, `issuer`, `metal_level`, `plan_type`, `cost_sharing` | `id`, `name`, `issuer`, `state`, `metal_level`, `plan_type`, `cost_sharing`, `premiums`, `links` | | `standard` | everything but `links` | everything but `variants` | | `full` (the default) | every field | every field | ## What to show your users 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 dataset - 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.