PlanVoyager

Find ACA Marketplace plans for a household, with the premium tax credit applied and plans ranked by estimated total yearly cost. Also reports the monthly tax credit, cost-sharing reduction (extra-savings Silver) eligibility and likely Medicaid eligibility.

{
  "type": "object",
  "properties": {
    "zip": {
      "description": "5-digit US ZIP code",
      "type": "string",
      "pattern": "^\\d{5}$"
    },
    "ages": {
      "description": "Age of each person who needs coverage",
      "minItems": 1,
      "maxItems": 10,
      "type": "array",
      "items": {
        "type": "integer",
        "minimum": 0,
        "maximum": 120
      }
    },
    "annual_income": {
      "description": "Expected household income (MAGI) for the coverage year, in dollars. Needed for the tax credit.",
      "type": "number",
      "minimum": 0
    },
    "household_size": {
      "description": "People in the tax household, including those not enrolling. Defaults to the number of ages.",
      "type": "integer",
      "minimum": 1,
      "maximum": 15
    },
    "tobacco": {
      "description": "Tobacco use per person, same order as ages",
      "type": "array",
      "items": {
        "type": "boolean"
      }
    },
    "immigration_status": {
      "description": "Per person, same order as ages. citizen = U.S. citizen or national; eligible-alien = green card holder, Cuban/Haitian entrant or COFA migrant; lawfully-present = work or student visa, asylum, refugee, TPS, pending green card; not-lawfully-present = no lawful status, including DACA. From 2027 only citizens and eligible aliens get the tax credit. Defaults to citizen.",
      "type": "array",
      "items": {
        "type": "string",
        "enum": [
          "citizen",
          "eligible-alien",
          "lawfully-present",
          "not-lawfully-present"
        ]
      }
    },
    "expected_care": {
      "description": "checkups = preventive only; some = a few visits; ongoing = a chronic condition or regular meds",
      "default": "some",
      "type": "string",
      "enum": [
        "checkups",
        "some",
        "ongoing"
      ]
    },
    "big_event": {
      "description": "Anything big planned this year",
      "default": "none",
      "type": "string",
      "enum": [
        "none",
        "baby",
        "surgery"
      ]
    },
    "metal": {
      "description": "Only this metal tier",
      "type": "string",
      "enum": [
        "bronze",
        "silver",
        "gold",
        "platinum",
        "catastrophic"
      ]
    },
    "limit": {
      "default": 8,
      "type": "integer",
      "minimum": 1,
      "maximum": 25
    }
  },
  "required": [
    "zip",
    "ages"
  ],
  "$schema": "https://json-schema.org/draft/2020-12/schema"
}

Full details for one plan: deductible, out-of-pocket max, copays, drug tiers, key benefits, and what the person would pay in the plan's official coverage examples (having a baby, managing diabetes, a simple fracture).

{
  "type": "object",
  "properties": {
    "plan_id": {
      "description": "plan_id from search_plans, e.g. 16842FL0120001-04",
      "type": "string",
      "minLength": 10
    }
  },
  "required": [
    "plan_id"
  ],
  "$schema": "https://json-schema.org/draft/2020-12/schema"
}

Look up a medication by name (generic or brand) to get its RxCUI, needed by check_coverage. Pick the entry matching the strength and form the person takes.

{
  "type": "object",
  "properties": {
    "query": {
      "description": "Drug name, e.g. \"metformin\" or \"Ozempic\"",
      "type": "string",
      "minLength": 3
    }
  },
  "required": [
    "query"
  ],
  "$schema": "https://json-schema.org/draft/2020-12/schema"
}

Look up a doctor near a ZIP code to get their NPI, needed by check_coverage.

{
  "type": "object",
  "properties": {
    "query": {
      "description": "Doctor's name",
      "type": "string",
      "minLength": 3
    },
    "zip": {
      "description": "5-digit ZIP near the doctor",
      "type": "string",
      "pattern": "^\\d{5}$"
    }
  },
  "required": [
    "query",
    "zip"
  ],
  "$schema": "https://json-schema.org/draft/2020-12/schema"
}

Check whether plans cover specific medications (by RxCUI) and have specific doctors in network (by NPI). Use search_drugs and search_doctors first to get the ids.

{
  "type": "object",
  "properties": {
    "plan_ids": {
      "description": "plan_id values from search_plans",
      "minItems": 1,
      "maxItems": 25,
      "type": "array",
      "items": {
        "type": "string",
        "minLength": 10
      }
    },
    "rxcuis": {
      "default": [],
      "maxItems": 10,
      "type": "array",
      "items": {
        "type": "string"
      }
    },
    "npis": {
      "default": [],
      "maxItems": 10,
      "type": "array",
      "items": {
        "type": "string"
      }
    }
  },
  "required": [
    "plan_ids"
  ],
  "$schema": "https://json-schema.org/draft/2020-12/schema"
}