Healthcare.gov Plan Scraper — ACA Marketplace Quotes & Benefits

Free-plan limit: Apify free-plan users receive at most 5 delivered records per run. Paid users may use the Actor’s configured result limit.

Extract ACA health insurance marketplace plans, monthly premiums, estimated subsidies, deductibles, out-of-pocket maximums, and benefit cost-sharings from Healthcare.gov.

The scraper queries Healthcare.gov's official Qualified Health Plan (QHP) marketplace endpoints for Federally Facilitated Marketplace (FFM) states. It retrieves both major medical and dental plans, complete with actuarial metal tiers, carrier details, and Summary of Benefits and Coverage (SBC) documents.

Key Features

• ZIP Code & County Search: Search across all FFM states (such as Florida, Texas, North Carolina, Georgia, Ohio, etc.) by 5-digit ZIP code with automatic county FIPS resolution.
• Subsidy & Demographic Calculation: Calculate Advance Premium Tax Credit (APTC) subsidies and net monthly premiums based on annual household income, applicant age, gender, and tobacco usage.
• Granular Filters: Filter by metal level (Catastrophic, Bronze, Expanded Bronze, Silver, Gold, Platinum), network type (HMO, PPO, EPO, POS), carrier name, and HSA eligibility.
• Direct Plan ID Lookup: Retrieve detailed plan sheets, exclusions, and SBC scenarios (maternity delivery, diabetes management, fracture care) using standard 14-digit QHP IDs.
• Standalone Dental Plans: Query pediatric and adult individual dental insurance plans.
• County Lookup Mode: Discover valid county names and FIPS codes for any US ZIP code.

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Input Parameters

Parameter	Type	Default	Description
mode	String	"search"	Extraction mode: "search" (by ZIP), "plan_ids" (direct QHP ID lookup), or "counties" (county lookup).
zipCode	String	"33101"	5-digit US ZIP code to search. Must be located in a Healthcare.gov FFM state.
countyFips	String	""	Optional 5-digit county FIPS code (e.g. "12086"). If blank, automatically resolves the primary county.
planIds	Array	[]	Specific 14-digit QHP plan IDs to look up when mode is "plan_ids" (e.g. ["21525FL0020004"]).
year	Integer	2026	Marketplace coverage year (2024–2030).
division	String	"HealthCare"	Plan category: "HealthCare" for major medical or "Dental" for dental plans.
income	Number	35000	Annual household income in USD for APTC tax credit subsidies. Set -1 for unsubsidized full-price quotes.
age	Integer	30	Applicant age (0–120) for age-rated premium calculation.
gender	String	"Female"	Applicant gender ("Female" or "Male").
usesTobacco	Boolean	false	Whether the applicant uses tobacco products.
aptcEligible	Boolean	true	Whether the applicant is eligible for premium tax credits.
metalLevels	Array	[]	Optional metal tier filter (e.g. ["Bronze", "Silver", "Gold"]).
planTypes	Array	[]	Optional plan type filter (e.g. ["HMO", "PPO", "EPO"]).
issuers	Array	[]	Optional carrier name filter (e.g. ["Oscar", "Blue Cross", "Aetna"]).
hsaEligibleOnly	Boolean	false	Filter to only Health Savings Account (HSA) eligible plans.
sortBy	String	"premium"	Sort order: "premium", "deductible", or "oopc".
sortOrder	String	"asc"	Sort direction: "asc" or "desc".
maxItems	Integer	20	Maximum plans written to the dataset (1–500).
fetchFullDetails	Boolean	false	When true in search mode, fetches individual SBC scenario details for each plan.

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Example Inputs

1. Default Medical Plan Search (Miami, FL)

{
  "mode": "search",
  "zipCode": "33101",
  "year": 2026,
  "division": "HealthCare",
  "income": 35000,
  "age": 30,
  "maxItems": 20
}

2. Silver & Gold HMO Plans with HSA Compatibility (Dallas, TX)

{
  "mode": "search",
  "zipCode": "75001",
  "year": 2026,
  "metalLevels": ["Silver", "Gold"],
  "planTypes": ["HMO"],
  "hsaEligibleOnly": true,
  "income": 45000,
  "maxItems": 25
}

3. Direct QHP Plan ID Lookup

{
  "mode": "plan_ids",
  "planIds": ["21525FL0020004"],
  "year": 2026
}

4. Standalone Dental Plans Search

{
  "mode": "search",
  "zipCode": "28202",
  "division": "Dental",
  "maxItems": 15
}

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Output Data Structure

Each record stored in the dataset represents a validated health insurance plan with normalized fields:

Field	Type	Description
recordType	String	"plan" for health plan records, "county" for county lookup records.
planId	String	Unique 14-digit Qualified Health Plan (QHP) identifier (e.g. "21525FL0020004").
name	String	Official marketing name of the health plan.
state	String	2-letter US state abbreviation (e.g. "FL", "TX").
year	Integer	Marketplace benefit year (e.g. 2026).
market	String	Market segment ("Individual" or "SHOP").
division	String	"HealthCare" or "Dental".
metalLevel	String	Actuarial tier: "Catastrophic", "Bronze", "Expanded Bronze", "Silver", "Gold", or "Platinum".
planType	String	Plan network type: "HMO", "PPO", "EPO", or "POS".
designType	String / Null	Plan variant or design standard.
isStandardizedPlan	Boolean	Whether the plan is a CMS standardized plan option.
hsaEligible	Boolean	Health Savings Account compatibility.
specialistReferralRequired	Boolean	Whether visiting a specialist requires a PCP referral.
hasNationalNetwork	Boolean	Whether the carrier provides a nationwide provider network.
premium	Number	Unsubsidized gross monthly premium in USD.
premiumWithCredit	Number	Net monthly premium after estimated APTC subsidy in USD.
ehbPremium	Number	Essential Health Benefits portion of premium.
aptcEligiblePremium	Number	Portion of premium eligible for tax credit calculation.
deductibleIndividual	Number / Null	Individual in-network medical & drug deductible.
deductibleFamily	Number / Null	Family in-network medical & drug deductible.
moopIndividual	Number / Null	Individual maximum out-of-pocket spending limit.
moopFamily	Number / Null	Family maximum out-of-pocket spending limit.
qualityRating	Number / Null	CMS Quality Star Rating (1–5 stars).
issuer	Object	Insurance company info (carrier ID, name, state, website URL, phone).
benefits	Array	Covered benefits with in-network copays and coinsurance rates.
diseaseManagementPrograms	Array	Offered disease management programs (e.g. Asthma, Diabetes).
brochureUrl	String / Null	Link to official plan brochure.
summaryOfBenefitsUrl	String / Null	Link to official Summary of Benefits and Coverage (SBC) PDF.
formularyUrl	String / Null	Link to carrier's covered drug formulary.
providerNetworkUrl	String / Null	Link to carrier doctor and hospital directory.
sbcScenarios	Object / Null	Standard SBC scenarios (having a baby, diabetes care, simple fracture).
searchLocation	Object	ZIP code, county name, county FIPS, and state searched.
scrapedAt	String	ISO 8601 timestamp of extraction.

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Pricing (Pay-Per-Event)

This Actor uses transparent Pay-per-event (PPE) pricing. Platform usage is included in the event prices; no separate per-run platform-usage fee is passed to users.

Event	Tier	Price (USD)	When Charged
apify-actor-start	FREE / BRONZE / SILVER / GOLD	$0.005	Synthetic event charged once when the Actor run initializes.
plan-scraped	FREE	$0.0040	One charge for each validated health plan record written to the dataset.
plan-scraped	BRONZE (2.5% discount)	$0.0039	Volume tier discount.
plan-scraped	SILVER (5.0% discount)	$0.0038	Volume tier discount.
plan-scraped	GOLD (20.0% discount)	$0.0032	Volume tier discount.

Representative Run Costs

• Quick Plan Comparison (10 plans): $0.005 (start) + (10 × $0.004) = $0.045
• Comprehensive Market Survey (50 plans): $0.005 (start) + (50 × $0.004) = $0.205
• Multi-County Extraction (100 plans): $0.005 (start) + (100 × $0.004) = $0.405

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State Coverage Notice

Healthcare.gov provides marketplace plan data for states utilizing the Federally Facilitated Marketplace (FFM) and State-Based Exchanges on the Federal Platform (SBM-FP), covering over 30 US states (including FL, TX, NC, SC, GA, OH, MI, IL, IN, MO, TN, AL, AZ, WI, VA, OK, UT, and others).

States operating fully autonomous state exchanges (such as California via Covered California, New York via NY State of Health, Massachusetts via Health Connector, and Washington via Healthplanfinder) do not list plans on Healthcare.gov. Querying ZIP codes in those states will return an informative notice without charging for plan results.

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Run with Apify API

import { ApifyClient } from 'apify-client';

const client = new ApifyClient({
    token: process.env.APIFY_TOKEN,
});

const run = await client.actor('muhammadafzal/healthcare-gov-plan-scraper').call({
    mode: 'search',
    zipCode: '33101',
    year: 2026,
    division: 'HealthCare',
    income: 35000,
    age: 30,
    maxItems: 20
});

const { items } = await client.dataset(run.defaultDatasetId).listItems();
console.log(`Retrieved ${items.length} health plans`);
console.log(items[0]);

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Responsible Use & Compliance

This Actor extracts public Qualified Health Plan data published by the Centers for Medicare & Medicaid Services (CMS) on Healthcare.gov for research, market intelligence, rate comparison, and consumer decision support.

• It does not access private health information (PHI), personal records, or enrollment credentials.
• Premium quotes and subsidies are estimates based on standard CMS formulas and do not constitute official eligibility determinations or insurance binders.