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Centers for Medicare and Medicaid Services Insurance Plans API

Data on both health and dental insurance plans.

Centers for Medicare and Medicaid Services Insurance Plans API is one of 16 APIs that Centers for Medicare and Medicaid Services publishes on the APIs.io network, described by a machine-readable OpenAPI specification.

Tagged areas include Insurance Plans. The published artifact set on APIs.io includes an OpenAPI specification, API documentation, authentication docs, and a GitHub repository.

This API exposes 6 operations across 6 paths, and defines 35 schemas. It is described by OpenAPI 2.0, at version 1.

Requests are made against the base URL https://marketplace.api.healthcare.gov/api/v1.

6 operations 6 paths 35 schemas 3 GET3 POST

Metadata

The identity and technical contract details declared by the specification.

Specification
OpenAPI 2.0
API Version
1
Base URL
https://marketplace.api.healthcare.gov/api/v1
Authentication
API Key
Resource Areas
1

Authentication & Security 1

Centers for Medicare and Medicaid Services Insurance Plans API declares 1 security scheme for authenticating requests. An API key is passed in the query as apikey (API Key). By default, every request must be authenticated.

  • API Key — Your API key should be included as a query parameter with the request. You can [fill out this form](https://cms.gov1.qualtrics.com/jfe/form/SV4N2GHCJfNuX7n8x)…

Paths & Operations 6

Across 6 paths, the API surfaces 6 operations — 3 GET, 3 POST. Each is listed below with its method, path, parameters, and response codes.

Insurance Plans 6

Data on both health and dental insurance plans.

GET
/crosswalk
Crosswalk a previous year plan
6 params → 200
POST
/plans
Get multiple plans
3 params → 200
POST
/plans/search
Search for insurance plans
3 params → 200
POST
/plans/search/stats
Retrieve stats on groups of insurance plans
3 params → 200
GET
/plans/{plan_id}
Get a plan
3 params → 200
GET
/plans/{plan_id}/quality-ratings
Quality ratings for a plan. If a rating value is missing or is 0, then the rating is considered 'Not Rated' and the corresponding reason value will indicate the reason for the non-rating.
3 params → 200

Schemas 35

The contract defines 35 schemas that model the data the API accepts and returns. The most detailed are Plan (39 properties), PlanSearchFilter (22 properties), Person (14 properties), PlanSearchRequest (12 properties). Each schema is shown below with its type and property counts.

RateArea
object
2 properties
QualityRating
object
10 properties
FamilyCostEnum
string
family cost enumeration for MOOPs and deductibles
GenderEnum
string
SBCScenario
object
4 properties
Person
object
14 properties 2 required
PlanTypeEnum
string
Deductible
object
8 properties
MOOP
object
maximum out-of-pocket
8 properties
DiseaseMgmtProgramsEnum
string
PlanIDList
array
PlanSearchRequest
object
12 properties 2 required
SuppressionStatus
string
Range
object
2 properties
Plan
object
39 properties
MetalLevelEnum
string
CSRRequestEnum
string
Cost-sharing reduction (CSR) override for requests
PlanSearchFilter
object
plan search filter
22 properties
DesignTypeEnum
string
Issuer
object
8 properties
CurrentEnrollment
object
Current/existing enrollment information used to determine tobacco status for CiC enrollments. This will ensure rate calculation is done correctly.
3 properties 3 required
ProductDivisionEnum
string
UtilizationEnum
string
MetalDesignType
object
2 properties
MarketEnum
string
Relationship
string
Should match one of the [listed valid relationships](introduction/more-information-about-households).
Place
object
3 properties 3 required
PlanID
string
InsuranceMarketEnum
string
NetworkTierEnum
string
CertificationStatus
string
CostSharing
object
7 properties
CostSharingReductionEnum
string
Cost-sharing reduction (CSR)
Benefit
object
8 properties
Household
object
If a household is not included, will default to Individual household
5 properties

Specification

The full machine-readable OpenAPI contract behind this narrative.

Source

cms-insurance-plans-api-openapi.yml Raw ↑

Other APIs Centers for Medicare and Medicaid Services publishes across the network.

CMS Beneficiary Claims Data API (BCDA)
CMS AB2D API (Claims Data to Part D Sponsors)
CMS Data at the Point of Care (DPC) API
CMS Finder API
CMS Quality Payment Program (QPP) Submissions API
Centers for Medicare and Medicaid Services API Reference API
Centers for Medicare and Medicaid Services Bulk Data API
Centers for Medicare and Medicaid Services Code Search API
Centers for Medicare and Medicaid Services Cost Search API
Centers for Medicare and Medicaid Services Enrollments API
Centers for Medicare and Medicaid Services Geography API
Centers for Medicare and Medicaid Services Households & Eligibility API