Marketplace API Use Cases
Case Study: Window Shopping
The HealthCare.gov Window Shopping application helps logged out users get a feel for the plans available to them and the premiums they carry, before entering into the enrollment flow.
On entry into the app, a user enters their ZIP Code. This ZIP Code is then looked up to determine which FIPS codes map to that ZIP Code. The user then selects a county, and the state attached to that county is looked up to see if it is an FFM-eligible state. If it is not, the user is directed to resources for their state. If it is, the user can proceed.
If the app is accessed during Open Enrollment, the user is prompted to ask if they had marketplace coverage during the current year. If they enter their plan ID, it is crosswalked over to the plan ID they will be auto-enrolled in if they take no action, so that they can compare it against other plans.
The user enters demographic information like household size, ages of members, and income. This information is then used to determine an eligibility estimate. This estimate will provide information as to whether household members are eligible for marketplace coverage (as opposed to being eligible for Medicaid or CHIP coverage), and will also return an estimated maximum APTC value.
Users are then prompted to either enter utilization levels, which will aid in determining out-of-pocket cost, or skip said process. Users can then optionally search for providers and drugs. If there are more results than can fit on one page, users can paginate through results for either providers or drugs. The user may add providers and drugs from the results to see what plans cover their providers and drugs when they get to the plan-browsing stage at the end.
After provider and drug search, users are sent to view plans. Before viewing plans, however, a modal is popped open to provide overview information to the user. Statistics are pulled from the available plan set to provide average premium and out-of-pocket cost (if calculated) per metal level, as well as presence of simple choice plans (only in pilot states). The user is allowed to filter based on a set of these attributes, then is shown plans.
On showing plans, the user is also shown whether these plans cover their providers and drugs if they have entered any. The user can then select plans to compare, or view their details.