Medicare Advantage

Quote applicants for Medicare Advantage and Part D benefits

Ideon's API delivers quotes for Medicare Advantage and Part D benefits through the "Medicare Advantage Plan Search" endpoint (API docs). In our documentation and Postman Collections, Medicare Advantage quoting will commonly be referred to as "MedAdv Quoting". The recommended integration flow is identical to ACA Medical - please refer to this section for integration tips.

Medicare Advantage Benefits

Development of a complete Medicare Advantage benefit grammar guide is in progress. For now, please refer to the Medical Grammar Guide for high-level information on grammar standardization for cost shares and some shared metadata fields.

A note on identifiers: Medicare Advantage plans have two unique identifiers returned in the benefits schema. The id field is an Ideon identifier unique to the given plan. The value in the identifiers array associated with "type": "medicare_plan_id" - for example, H0523-022-0 - is the carrier plan identifier, unique to the given plan year. This is made up of the carrier contract/bid ID, plan ID, and segment ID.

Decision Support Features

For both Individual Medical and Medicare Advantage quoting, provider and drug details can be included to check for in-network and formulary coverage within each plan. See the following sections for details on these use cases.

• Shop by Doc - check network participation for selected providers and optionally, their addresses, for each plan quoted.