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Marketplace API Specification

Use the API that powers HealthCare.gov to develop applications with health insurance plans, providers, and coverage information for issuers on the exchange.

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Marketplace API
 1 

[ Base URL: marketplace.api.healthcare.gov/api/v1 ]

About

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. Request an API token here, or learn more from the developer site.

Retention

Marketplace API data includes at minimum the last three years of data.

Limitations

API keys are rate limited. This rate limit is passed along in the Header information provided. If you have concerns with the rate limit, please reach out to the Marketplace API team.

Quickstart

This section will cover a short workflow for a common scenario — looking up insurance plans for a person's household with premiums and estimated tax credits, obtaining details about a particular plan, and looking up the drug coverage for a specific plan. Other endpoints, like looking up doctors and providers, or getting recent state medicaid information, are covered in the docs.

Search for health insurance plans

We begin by searching for the health insurance plans for a 27 year-old woman living in North Carolina by posting a single person household to the plan search endpoint

apikey="d687412e7b53146b2631dc01974ad0a4" # rate limited test key
curl --request POST \\
  --url "https://marketplace.api.healthcare.gov/api/v1/plans/search?apikey=${apikey}" \\
  --header 'content-type: application/json' \\
  --data '{
    "household": {
      "income": 52000,
      "people": [
        {
          "age": 27,
          "aptc_eligible": true,
          "gender": "Female",
          "uses_tobacco": false
        }
      ]
    },
    "market": "Individual",
    "place": {
      "countyfips": "37057",
      "state": "NC",
      "zipcode": "27360"
    },
    "year": 2019
}'

This POST request returns health insurance information and pricing estimates for the plans for which she can sign up. More discussion about building the household JSON object can be found later on this page. Don't know the county FIPS code? To look it up for this person's zip code, we use the counties by zip endpoint.

apikey="d687412e7b53146b2631dc01974ad0a4"
zipcode="27360"
curl "https://marketplace.api.healthcare.gov/api/v1/counties/by/zip/${zipcode}?apikey=${apikey}"

This helps gather the necessary information to build the household object to submit to the API.

Get details about a specific health insurance plan

With a plan search completed, let's look more closely at a particular plan. For example, Blue Cross Blue Shield of North Carolina Blue Value Catastrophic was one of the first returned from the example above. We will use it as an example to drill down

apikey="d687412e7b53146b2631dc01974ad0a4"
planid="11512NC0100031"
year="2019"
curl "https://marketplace.api.healthcare.gov/api/v1/plans/${planid}?year=${year}&apikey=${apikey}"

Using this endpoint will provide more granular information about the particular plan for a searching user, like issuer information, cost sharing deductibles, eligible dependents, website urls, quality ratings, and more.

Standard Plans

Some plans are considered standard plans. These can be identified in the results of a plan search or plan details endpoint. If a plan has a design_type that is one of the following, it is considered a standard plan: "DESIGN1", "DESIGN2", "DESIGN3", "DESIGN4", "DESIGN5". If a plan has a design_type of "NOT_APPLICABLE", then it is not considered a standard plan.

Get drug coverage information about a health insurance plan

Now that we have a plan of interest, let's look up what drugs it covers. We want to know if ibuprofen is covered under the insurance plan. First, we can mimic a user interaction with an autocomplete for ibuprofen for a typeahead.

apikey="d687412e7b53146b2631dc01974ad0a4"
query="ibuprof"
curl "https://marketplace.api.healthcare.gov/api/v1/drugs/autocomplete?q=${query}&apikey=${apikey}"

Among other things, this provides us with an RxCUI, a unique identifier for a clinical drug. We can use it along with the plan id to query the API for whether or not ibuprofen is covered under this plan

apikey="d687412e7b53146b2631dc01974ad0a4"
drugs="1049589"
planids="11512NC0100031"
year="2019"
curl "https://marketplace.api.healthcare.gov/api/v1/drugs/covered?year=${year}&drugs=${drugs}&planids=${planids}&apikey=${apikey}"

The API confirms that ibuprofen is covered.

More information about households

The household in the example above was sufficient to query Marketplace API, but there are more optional fields that can provide more accurate search results and premium estimates, or can be used by application developers to specify scenarios. For example, if a household does not live together, certain plans may no longer be eligible to them.

We begin with an example, describing what some of the less intuitive fields means. Here's the JSON of a fully filled in household, using all possible features

{
  "aptc_override": 288.61,
  "household": {
    "effective_date": "2019-05-01",
    "has_married_couple": true,
    "income": 52000,
    "unemployment_received": Adult,
    "people": [
      {
        "age": 27,
        "dob": "1992-01-01",
        "aptc_eligible": true,
        "does_not_cohabitate": false,
        "gender": "Female",
        "has_mec": false,
        "is_parent": false,
        "is_pregnant": false,
        "relationship": "Self",
        "uses_tobacco": false,
        "utilization": "Medium"
      },
      {
        "age": 25,
        "dob": "1994-03-03,
        "aptc_eligible": true,
        "does_not_cohabitate": false,
        "gender": "Male",
        "has_mec": false,
        "is_parent": false,
        "is_pregnant": false,
        "relationship": "Spouse",
        "uses_tobacco": false,
        "utilization": "Medium"
      }
    ]
  },
  "market": "Individual",
  "place": {
    "countyfips": "37057",
    "state": "NC",
    "zipcode": "27360"
  },
  "year": 2019
}

APTC Override

The aptc_override is an optional override to specify the Advanced Premium Tax Credit for a user, if the exact value is already known. For persons in the household, aptc_eligible denotes if the person is eligible for the Advanced Premium Tax Credit.

Unemployment Received

As part of the American Rescue Plan, if the household has received unemployment benefits during 2021 the household income must be capped to 133% of the Federal Poverty Level for the household size in APTC and CSR estimations. If the recipient is an adult tax payer, both ATPC and CSRs will be affected. If only a tax dependent received unemployment, the only effect will be to CSR eligibility.
If both an adult and dependent have received unemployment, "Adult" should be passed so that the maximum APTC and CSRs are received.
This field defaults to None if not included and only affects the 2021 market year.

Effective Date

This is the date a plan or coverage goes into effect and is used in premium calculations and determining eligibility. If omitted, the value defaults to the effective date of the plan, which is generally Jan 1 of the market year. The effective_date is required to correctly calculate the number of months since an individual has used tobacco. The number of months is the difference of the last tobacco use date until the effective_date. Considering the number of months since last tobacco use can impact the rate charged by a plan, this field is required to be included for a more accurate search result.

Age Calculation

Either an age or dob value must be provided. If age is provided that value is used in determining eligibility and premiums. If a dob is provided, a more accurate age is calculated using the combination of dob, the effective date, and plan specific rating-age adjustments. If both fields are populated, age takes precedence and no calculation will occur.

Plan rates can have age adjustments affecting what premiums get returned. Additionally, effective date in relation to age affects premium calculation and eligibility. Therefore, determining the correct age is important for accurate results.

Cohabitation

does_not_cohabitate indicates whether the person is living with the household.

Minimal Essential Coverage (MEC)

has_mec indicates whether a person has Medicaid/CHIP and may possibly not be included in the household for premium determination and insurance eligibility.

Relationship

relationship — which is not required to issue a request — is the relationship of a household member to the person applying for health insurance. For the main enrollee, the Self relationship is used.

Each plan on the marketplace defines a set of dependent relationships within a household as eligible to enroll in that plan.

If it is known by the caller what relationships exist within a household when making a request to Marketplace API, the API can more accurately determine household eligibility for plans. If the relationship field is used in a request, it must be a valid relationship for the provided market year (see list below).
When a household request is sent without relationships present in the household, Marketplace API will make as accurate an eligibility determinaton as possible without the relationship values.

The total set of dependent relationships that plans may use to restrict eligibility may change over the years. For 2020 and 2021, the possible relationship types that plans may utilize are as follows

20202021
SelfSelf
Brother or SisterBrother or Sister
ChildChild
Collateral DependentCollateral Dependent
Ex-SpouseEx-Spouse
Foster ChildFoster Child
Grandson or GranddaughterGrandson or Granddaughter
Life PartnerLife Partner
Nephew or NieceNephew or Niece
Other RelationshipOther Relationship
Other RelativeOther Relative
Sponsored DependentSponsored Dependent
SpouseSpouse
Stepson or StepdaughterStepson or Stepdaughter
WardWard
Adopted Child
Annultant
Brother-in-Law or Sister-in-Law
Court Appointed Guardian
Dependent of a Minor Dependent
Guardian
Son-in-Law or Daughter-in-Law
Stepparent

As can be seen from this list, the list of potential relationships has been simplified between 2020 and 2021. When a relationship is not one of the obvious choices in this list, the fallback values of Other Relative and Other Relationship may be used.

Utilization

Finally, utilization is one of {"Low", "Medium", "High"} and is a description of how much a person intends to use their health insurance.

Bulk Data

Marketplace API offers various endpoints that offer bulk data. These endpoints will pass large JSON data sets through that are stored in s3. Currently these are only supported for the current and previous market years.

Understanding Errors

The Marketplace API returns standard HTTP status codes which indicate whether a specific HTTP request has successfully completed. For some errors, additional information is provided in the response body, including an application error code and a brief message.

HTTP Response Status Codes

Responses are grouped in five classes:

  • Successful responses (200–299)
  • Client errors (400–499)
  • Server errors (500–599)

Marketplace API Error Codes

The various codes are listed below:

1000 - errInternalServerError |

The Internal Server Error response code indicates that the server encountered an unexpected condition that prevented it from fulfilling the request.

  Request:  GET /api/v1/drugs/search?q=...
  Response: {
              "code": "1000",
              "status": "500",
              "message": "Internal server error",
              "error": "sql: Scan called without calling Next"
            }

1001 - errCountyNotFound |

This error code is returned by the County Lookup by FIPS endpoint when no county is found using the FIPS provided in the request. For example:

  Request:   GET /api/v1/counties/35094
  Response:  {
                "code": "1001",
                "status": "404",
                "message": "county not found"
                "error": "sql: No records found"
              }

1002 - errStateNotFound |

This error code is returned by the Lookup State endpoint when no state is found using the state provided in the request. For example:

  Request:   GET /api/v1/states/NP
  Response:  {
                "code": "1002",
                "status": "404",
                "message": "state not found"
                "error": "sql: No records found"
              }

1003 - errInvalidInput |

This error code is returned by various endpoints when the required input is invalid. The message provided in the response will assist in resolving the problem before re-sending the request. For example:

  Request:   GET /api/v1/issuers/1019
  Response:  {
                  "code": "1003",
                  "status": "400",
                  "message": "invalid issuers request"
                  "error": "invalid issuer ID format"
              }

1004 - errIssuerNotFound |

This error code is returned by the Get Issuer endpoint when no issuer is found using the issuer id provided in the request. For example:

  Request:   GET /api/v1/issuers/01922
  Response:  {
                "code": "1004",
                "status": "404",
                "message": "issuer not found"
                "error": "sql: No records found"
              }

1005 - errCrosswalkNotFound |

This error code is returned by the Crosswalk a previous year plan endpoint when no crosswalk is found using the parameters provided in the request. For example:

  Request:   GET /api/v1/crosswalk&year=2018&plan_id=53882IL0040002&state=IN
             &zipcode=60647&fips=17031
  Response:  {
                "code": "1005",
                "status": "404",
                "message": "No crosswalk found for those parameters"
                "error": "sql: No records found"
              }

1006 - errPlanNotFound |

This error code is returned by various endpoints when no plan is found using the parameters provided in the request. For example:

  Request:   GET /api/v1/plans/11512NC0100035
  Response:  {
                "code": "1006",
                "status": "404",
                "message": "Plan not found"
                "error": "sql: No records found"
              }

1007 - errTimeout |

This error code is returned by various endpoints when the request timed out. For example:

  Request:   various endpoints
  Response:  {
                "code": "1007",
                "status": "500",
                "message": "request timed-out, try again"
                "error": "db query timed-out"
              }

1008 - errStateMedicaidNotFound |

This error code is returned by the State Medicaid Data endpoint when no medicaid is found using the parameters provided in the request. For example:

  Request:   GET /api/v1/states/NV/medicaid
  Response:  {
                "code": "1008",
                "status": "404",
                "message": "state medicaid not found"
                "error": "year out of range"
              }

1009 - errPovertyGuidelineNotFound |

This error code is returned by the State Poverty Guidelines endpoint when no U.S. federal poverty guidelines is found using the parameters provided in the request. For example:

  Request:   GET /api/v1/states/XX/poverty-guidelines
  Response:  {
                "code": "1009",
                "status": "400",
                "message": "poverty guideline not found"
                "error": "sql: No records found"
              }

1010 - errPercentageFPLNotFound |

This error code is returned by the Poverty Level Percentage endpoint when no percentage of federal poverty level is found using the parameters provided in the request. For example:

  Request:   GET /api/v1/households/pcfpl&year=2021&state=NV&size=2&income=14000
  Response:  {
                "code": "1010",
                "status": "404",
                "message": "percentage of federal poverty level not found"
                "error": "guideline not found for state: NV, year: 2021"
              }

1011 - errQualityRatingNotFound |

This error code is returned by the Quality Ratings endpoint when there are no quality ratings for a plan. For example:

  Request:   GET /api/v1/plans/XXXXXXXXXXX/quality-ratings&year=2021
  Response:  {
                "code": "1011",
                "status": "404",
                "message": No quality rating found for those parameters"
                "error": "sql: No records found"
              }

1012 - errCoverageUnavailable |

This error code is returned by various endpoints when the coverage data is temporarily unavailable. For example:

  Request:   various endpoints
  Response:  {
                "code": "1012",
                "status": "503",
                "message": "coverage data temporarily unavailable"
                "error": "coverage database unavailable"
              }

1013 - errProviderNotFound |

This error code is returned by various Provider related endpoints when the provider is not found. For example:

  Request:   various endpoints
  Response:  {
                "code": "1013",
                "status": "404",
                "message": "provider not found"
                "error": "sql: No records found"
              }

1014 - errDrugNotFound |

This error code is returned by various Drug related endpoints when the drug is not found. For example:

  Request:   various endpoints
  Response:  {
                "code": "1014",
                "status": "404",
                "message": "drug not found"
                "error": "sql: No records found"
              }

1015 - errMissingMedicaidCHIPEligibility |

This error code is returned when no Medicaid CHIP Eligibility plans are found using the parameters provided in the request.

  Request:   POST /api/v1/households/eligibility/estimates
  Response:  {
                "code": "1015",
                "status": "404",
                "message": "missing medicaid eligibility data"
                "error": "missing eligibility for fiscal year: YYYY, quarter: Q, state: SS"
              }

1016 - errTooFewPlans |

This error code is returned when there are not enough plans in a given service area to compute a second lowest cost silver plan for an example, the errTooFewPlans code may be returned.

  Request:   POST /api/v1/households/eligibility/estimates
  Response:  {
                "code": "1016",
                "status": "404",
                "message": "not enough plans to calculate SLCSP/LCBP"
                "error": "not enough plans to calculate SLCSP/LCBP"
              }

1017 - errRateAreaNotFound |

This error code is returned by various Drug related endpoints when the rate area is not found. For example:

  Request:   GET /api/v1/rate-areas?state=IN&zipcode=60647&fips=17031
  Response:  {
                "code": "1017",
                "status": "404",
                "message": "rate area not found"
                "error": "No rate area could be determined"
              }

Marketplace API Common Error Codes

400 Bad Request - Client supplied invalid or incorrect values to the requested end-point
404 Not Found - End-point could not find the requested object(s)

Marketplace API Uncommon Error Codes

500 Internal Server Error - An unexpected error occurred
503 Service Unavailable - The requested service is temporarily unavailable, try again later.

Geography

Geographic data, including information on states, counties, and zipcodes.

Provider & Drug Coverage

Lookup information on providers, drugs, and what is covered under what plans.

GET​/drugs​/autocomplete
Autocomplete drugs by name
GET​/drugs​/covered
Get a list of whether drugs are covered by plans
GET​/coverage​/stats
Coverage statistics
GET​/providers​/autocomplete
Autocomplete nearby providers
GET​/providers​/covered
Get a list of whether a set of providers are covered by given plans

Households & Eligibility

Household specific calculations, including eligibility information, out of pocket costs, poverty levels, and cost benchmarks.

POST​/households​/eligibility​/estimates
POST​/households​/ichra
Get affordability and premium of the lowest cost silver plan
POST​/households​/lcbp
Get lowest cost bronze plan for a household
POST​/households​/slcsp
Get second lowest cost silver plan
POST​/households​/lcsp
Get lowest cost silver plan

Insurance Plans

Data on both health and dental insurance plans.

GET​/crosswalk
Crosswalk a previous year plan
POST​/plans
Get multiple plans
POST​/plans​/search
Search for insurance plans
POST​/plans​/search​/stats
Retrieve stats on groups of insurance plans
GET​/plans​/{plan_id}
Get a plan
GET​/plans​/{plan_id}​/quality-ratings

Insurance Issuers

Data related to health insurance issuers on the marketplace.

GET​/issuers
List issuers
GET​/issuers​/{issuer_id}
Get issuer

Enrollments

Enrollment grouping validation and information.

API Reference

Information about the state of Marketplace API.

Bulk Data

Information about the bulk data json files maintained by Marketplace API.

default

POST​/plans​/{plan_id}
Get plan details with premiums for a household

Models

Address
ApplicationError400
ApplicationError404
APT
APTTier
Benefit
CostSharing
Crosswalk
CrosswalkCode
CrosswalkData
CSRRequestEnum
CostSharingReductionEnum
CSREligibilityEnum
County
CurrentEnrollment
DataVersion
DecileEnum
DecileMapping
DecileUtilizationMapping
DecileUtilizationAgeMap
Deductible
DiseaseMgmtProgramsEnum
Drug
Coverage
DrugCoverage
Eligibility
FamilyCostEnum
HRA
Range
PlanSearchFilter
GenderEnum
Household
ICHRAResponse
LowestCostPlanHousehold
InsuranceMarketEnum
Issuer
MOOP
MarketYear
MarketYears
MarketEnum
MarketplaceModelEnum
MetalLevelEnum
DesignTypeEnum
MetalDesignType
NetworkTierEnum
Person
LowestCostPlanPerson
LowestCostPlanResponse
Place
Plan
PlanSearchRequest
PlanTypeEnum
ProductDivisionEnum
Provider
ProviderCoverage
ProviderGenderEnum
NearbyProvider
ProviderTypeEnum
QualityRating
RateArea
Relationship
SBCScenario
State
Guideline
PovertyGuideline
LowIncomeChild
StateMedicaidList
StateMedicaid
UtilizationEnum
ZIPCounty
NPI
PlanID
RxCUI
Enrollment
EnrollmentGroup
Enrollee
RelationshipEdge
ExtendedEnrollee
ExtendedEnrollment
APTC
APTCEnrollmentGroup
APTCEnrollee
APTCAllocationResult
FlattenedEnrollmentGroup
PlanIDList
SuppressionStatus
CertificationStatus
StateCounty
CountyZips
StateRateArea
RateAreaCounty