CMS — Centers for Medicare & Medicaid Services · Example Payload

Cms Gov Marketplace Plan Example

HealthcareMedicareMedicaidFHIRBulk DataOpen DataGovernmentFederalClaimsInsuranceACAMarketplaceQuality

Cms Gov Marketplace Plan Example is an example object payload from CMS — Centers for Medicare & Medicaid Services, with 14 top-level fields. It illustrates the shape of data this provider's APIs accept or return.

Top-level fields

idnameissuermetal_leveltypeyearpremiumpremium_w_creditdeductiblesmoopsbenefitshsa_eligiblenetwork_urlbenefits_url

Example Payload

{
  "id": "12345CT0010001-01",
  "name": "Anthem Silver Pathway HMO 5000",
  "issuer": {
    "id": "12345",
    "name": "Anthem Health Plans, Inc.",
    "state": "CT"
  },
  "metal_level": "Silver",
  "type": "HMO",
  "year": 2026,
  "premium": 542.18,
  "premium_w_credit": 162.18,
  "deductibles": [
    { "amount": 5000, "type": "Combined Medical and Drug EHB Deductible", "family_cost": "Per Person", "csr": "Standard" }
  ],
  "moops": [
    { "amount": 9450, "type": "Maximum Out of Pocket for Medical EHB Benefits", "family_cost": "Per Person", "csr": "Standard" }
  ],
  "benefits": [
    { "name": "Primary Care Visit to Treat an Injury or Illness", "covered": true, "cost_sharings": [ { "amount": "$30", "type": "Copay after deductible" } ] },
    { "name": "Generic Drugs", "covered": true, "cost_sharings": [ { "amount": "$10", "type": "Copay" } ] }
  ],
  "hsa_eligible": false,
  "network_url": "https://www.anthem.com/find-doctor/",
  "benefits_url": "https://www.anthem.com/individual-and-family/sbc/12345CT0010001-01.pdf"
}