BREAKING: The new phonebooks are here! The new phonebooks are here!
David Anderson is a very happy camper this morning...
— David Anderson (@bjdickmayhew) October 26, 2018
Here's what he's talking about: The massive searchable/filterable database which CMS maintains every year which includes pretty much every conceivable detail about every ACA-compliant health insurance policy available from every carrier in every region of all 39 states whose ACA exchanges are hosted on HealthCare.Gov (it doesn't include the 12 states which operate their own ACA exchanges, unfortunately).
Health Insurance Exchange Public Use Files (Exchange PUFs)
The Centers for Medicare & Medicaid Services (CMS) Center for Consumer Information and Insurance Oversight (CCIIO) is committed to increasing transparency in the Health Insurance Exchange. While health plan information including benefits, copayments, premiums, and geographic coverage is publically available on Healthcare.gov, CMS also publishes downloadable public use files (PUFs) so that researchers and other stakeholders can more easily access Exchange data.
The Health Insurance Exchange Public Use Files (Exchange PUFs) are available for plan years 2014 to 2019 to support timely benefit and rate analysis. It is important to note that the 2019 Exchange PUFs will be updated regularly to reflect the plan data that consumers will see when shopping for an Exchange Qualified Health Plan (QHP). Data for the 2019 Exchange PUFs were imported to CMS systems by September 28, 2018.
The Exchange PUFs include plan and issuer level information for certified Qualified Health Plans (QHPs) and stand-alone dental plans (SADPs) offered to individuals and small businesses through the Health Insurance Exchange. The Exchange PUFs include data from states participating in the Federally Facilitated Exchanges (FFE), State Partnership Exchanges (SPEs) and states whose State-based Exchanges rely on the federal information technology platform for QHP eligibility and enrollment functionality (SBE-FP). The PUFs also include data on Multi-State Plans (MSPs) and certified off-exchange SADPs. The Exchange PUFs exclude information from SBEs that do not rely on the federal platform for QHP eligibility and enrollment functionality.
The Exchange PUFs consist of ten separate files as described below:
- Benefits and Cost Sharing PUF (BenCS-PUF) – Plan variant-level data on essential health benefits, coverage limits, and cost sharing.
- Rate PUF (Rate-PUF) – Plan-level data on individual rates based on an eligible subscriber’s age, tobacco use, and geographic location, and family-tier rates.
- Plan Attributes PUF (Plan-PUF) – Plan-level data on maximum out of pocket payments, deductibles, HSA eligibility, formulary ID, and other plan attributes.
- Business Rules PUF (BR-PUF) – Plan-level data on rating business rules, such as allowed relationships (e.g., spouse, dependents) and tobacco use.
- Service Area PUF (SA-PUF) – Issuer-level data on geographic service areas including state, county, and zip code.
- Network (Ntwrk-PUF) – Issuer-level data identifying provider network URLs.
- Plan ID Crosswalk PUF (CW-PUF) – Plan-level data mapping plans offered in the previous plan year to plans offered in the current plan year.
- Machine-readable URL PUF (MR-PUF)—Issuer-level URL locations for machine-readable plan network provider and formulary information.
- Transparency in Coverage PUF (TC-PUF) – Issuer-level claims, appeals, and active URL data. The PY2019 PUF contains data from PY2017 for issuers participating in the Exchange in PY2017.
- Quality PUF (Qual-PUF) – Quality ratings data for plans in pilot states. The PY17 Quality PUF is found below. Quality PUFs for more recent plan years are found here.
Needless to say, other healthcare wonks and myself will be quite busy this weekend...