What does the Marketplace API offer?
The Marketplace API delivers data that helps users find and evaluate health care insurance plans, providers, and coverage information on the marketplace. It’s used by HealthCare.gov and other third party services.
Here are the data types in the Marketplace API:
- Affordable Care Act (ACA) plan benefit and rating data from issuers on the exchange
- Doctor, facility, and drug coverage for ACA plans
- Out-of-pocket-cost utilization data as calculated on behalf of CMS
- Medicaid and the Children’s Health Insurance Program (CHIP) eligibility estimate data
Why should I use this API?
Applications that use the Marketplace API can get live changes as soon as they’re posted on HealthCare.gov instead of loading them from a static data source (like PUF or QHP Landscape files). This lets you keep your plan data up to date and in sync with the Marketplace, so your users have the most accurate information to help them make decisions.
The Marketplace API is designed to support live access by front-end applications, it’s not designed to be scraped or for the whole data set to be extracted.
Who can use the Marketplace API?
API keys for the Marketplace API are for our partners in the Issuer Technical Workgroup.
How can I start using the Marketplace API?
You must be a CMS partner in the Issuer Technical Workgroup to request access. You can request access here: Marketplace API Key Request
You can find Marketplace API documentation on Apiary: Marketplace API Documentation
The Marketplace API drives Window Shop and Plan Compare on HealthCare.gov. Window Shop lets consumers preview plans and prices before they start the application and enrollment process. Plan Compare lets users pick the plan they want to enroll in after logging in. These products show consumers:
- Plans available to them based on their location and household makeup.
- If plans cover their specific providers and drugs.
- Their estimated total yearly costs based on how much health care they expect to use.
Third Party Adoption
You can use the Marketplace API to:
- Get eligibility estimates
- Figure estimated out-of-pocket costs based on health care utilization levels
- See which marketplace plans cover specific providers and drugs
- See and compare marketplace plan details
- Compare a current plan with next year’s plan
Machine readable tools
Machine Readable Tools are a newly redesigned self-service way for users to troubleshoot machine readable issues. Included are:
- JSON Validator: Check your JSON schema for errors, and how to troubleshoot them.
- Coverage Inspector: Find coverage information about issuers, providers, plans, and drugs.
- Knowledgebase FAQ: Need help? The knowledgebase is here to assist you.
Visit developer.cms.gov/marketplace-api/coverage-portal/ to learn more, and get started.
If you have questions or issues, contact us at: firstname.lastname@example.org