Benefits is two services, the two halves of Real-Time Benefits, a CMS Health Tech Ecosystem use case. One answers what a health plan covers and what a member pays; the other answers what a medication would cost.
What a Medicare Advantage or ACA Marketplace plan covers and what a member pays, read from the plan files CMS publishes and served as FHIR.
Plan design: the plan benefits every member of a plan shares, from the plan files CMS publishes.
View Medical BenefitsNot yet open to customers.
What a medication would cost, answered in real time: its price at pharmacies near a ZIP code with no patient details, or what it would cost a member under their pharmacy coverage.
The real-time pharmacy benefit check, as the CARIN Consumer Real-Time Pharmacy Benefit Check guide defines it.
Read the Pharmacy Benefits docsEvery API on the platform today is included in every plan. Free to start on the Developer plan.