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The Center for Consumer Information & Insurance Oversight

 

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 2020 to support timely benefit and rate analysis. It is important to note that the 2020 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 2020 Exchange PUFs were imported to CMS systems by October 25, 2019.

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 PY2020 PUF contains data from PY2018 for issuers participating in the Exchange in PY2018.
  • Quality PUF (Qual-PUF) – Quality ratings data for plans in pilot states. The PY2017 PUF is found below. The PY2018 PUF is found here.
  • Nationwide Quality Rating System PUF (NatQRS-PUF) – Quality ratings data for plans nationwide, including State Based Exchanges (SBE). The PY2019 and PY2020 PUFs are found here.

For more information about the Exchange PUFs, please review the General Information Factsheet, Data Disclaimer-User Agreement, and Data Dictionaries.

Health Insurance Exchange PUF Data Dictionaries
Benefits and Cost Sharing Data Dictionary
Rate Data Dictionary
Plan Attributes Data Dictionary
Business Rules Data Dictionary
Service Area Data Dictionary
Network Data Dictionary
Plan ID Crosswalk Data Dictionary
Machine-readable Data Dictionary
Transparency in Coverage Data Dictionary
Quality Data Dictionary
Nationwide Quality Rating System Data Dictionary

To access and download each PUF, click on the associated link in the Downloads section below.

Downloads

2020 Exchange PUF Datasets

2019 Exchange PUF Datasets

2018 Exchange PUF Datasets

2017 Exchange PUF Datasets

2016 Exchange PUF Datasets

2015 Exchange PUF Datasets

2014 Exchange PUF Datasets

Further Information

The plan year 2020 Exchange PUFs will be updated regularly to incorporate approved data corrections from issuers including Small Business Health Options Program (SHOP) quarterly rate updates. Note that data in the plan year 2020 Exchange PUFs may vary from the data shown on HealthCare.gov due to difference in dates between display of approved data changes and release of Exchange PUFs updates.