●5 Core Capabilities • 8,000+ Plans • 2026 CMS Data

How UniHealth Works

Our AI assistant combines 5 powerful capabilities to find your perfect Medicare plan. Real-time plan data, drug costs, and provider networks — all in one conversation.

AI Capabilities

8K+

Plans Indexed

537K

Provider Networks

100%

CMS Compliant

From Question to Answer in Seconds

Our AI understands your question, activates the right capabilities, and delivers personalized answers.

💬

Step 1

You Ask

Type your Medicare question in plain English

"I'm turning 65 and take Metformin. What plans cover my doctor?"

🧠

Step 2

AI Understands

Our AI identifies your needs and activates the right capabilities

Detected: Plan Finder + Drug Costs + Provider Network

⚡

Step 3

Real Data

We query our Medicare database for current plan information

Checking 8,000+ plans, drug costs, provider networks...

✨

Step 4

You Get Answers

Receive personalized recommendations with real costs

3 plans match: Dr. Smith in-network, Metformin $0, from $15/mo

📚 Official Medicare Knowledge Base

Powered by Official Government Sources

Every answer is backed by official documentation from CMS.gov, Medicare.gov, and SSA.gov — not random internet content.

📄

150K+

Pages Indexed

Official Medicare documentation

🏛️

Official Sources

CMS.gov • Medicare.gov • SSA.gov

🔄

Monthly

Updates

Always current

✓

100%

Cited Answers

Every answer links to source

What's in Our Knowledge Base

🏛️

CMS.gov

147,000+ sections

• Medicare rules & regulations
• Coverage decisions
• Enrollment procedures
• IRA drug pricing updates

📋

Medicare.gov

Consumer guides

• Medicare & You handbook
• Plan comparison guides
• Benefits explanations
• Educational materials

🔐

SSA.gov

Full handbook

• Social Security Handbook
• Medicare eligibility rules
• Premium calculations
• Enrollment periods

Automatically refreshed monthly from official government sources

🛠️ Tools by Plan Type

What We Check for Each Plan Type

Different plan types need different tools. Here's what our AI uses for each.

Tool	🏛️Original	⭐MA	💊PDP	🛡️Medigap	🦷DVH
1️⃣ ELIGIBILITY & TIMING Can I enroll? When? Penalties?
Enrollment Periods IEP, AEP, OEP check	check_enrollment_period get_current_period() chat.py	check_enrollment_period get_current_period() chat.py	check_enrollment_period get_current_period() chat.py	—	—
SEP Detection Special enrollment triggers	check_sep_eligibility detect_sep_triggers() chat.py	check_sep_eligibility detect_sep_triggers() chat.py	check_sep_eligibility detect_sep_triggers() chat.py	check_sep_eligibility detect_sep_triggers() chat.py	—
Part B LEP Part B late penalty	partb_calculate_lep calc_partb_penalty() chat.py	partb_calculate_lep calc_partb_penalty() chat.py	—	—	—
Part D LEP Part D late penalty	—	—	partd_calculate_lep facts.calculate_lep() facts.yaml	—	—
2️⃣ KNOWLEDGE What are my options?
Knowledge Search Medicare Q&A	medicare_search_knowledge rag_search() RAG DB	medicare_search_knowledge rag_search() RAG DB	medicare_search_knowledge rag_search() RAG DB	medicare_search_knowledge rag_search() RAG DB	medicare_search_knowledge rag_search() RAG DB
3️⃣ PLAN DISCOVERY What plans are available?
Plan Search Find plans in your ZIP	—	ma_search_plans get_plans_by_zip() Plans DB	pdp_search_plans get_pdp_plans() Plans DB	medigap_search_plans★ csg_db.get_quotes() CSG API	dvh_search_plans★ csg_dvh.get_quotes() CSG API
Benefits Details Copays, deductibles, MOOP	—	ma_get_benefits get_plan_by_bid() Plans DB	pdp_get_benefits get_pdp_details() chat.py	medigap_get_benefits load medigap_plans.yaml YAML	dvh_get_benefits parse_plan_details() CSG API
Plan Comparison Side-by-side compare	—	compare_plans compare_by_bids() chat.py	compare_plans compare_by_bids() chat.py	compare_plans compare_quotes() chat.py	compare_plans compare_quotes() chat.py
4️⃣ COVERAGE VALIDATION Will it work for me?
Provider Accepts Medicare Assignment status, opt-out	check_medicare_provider check_assignment_status() chat.py	—	—	check_medicare_provider check_assignment_status() chat.py	—
Plan Network Check In-network vs out-of-network	—	ma_check_network check_provider_network() Plans DB	—	—	—
Drug Cost Lookup Check medication costs	—	partd_check_drug get_drug_formulary() Plans DB	partd_check_drug get_drug_formulary() Plans DB	—	—
Drug Restrictions PA, step therapy, QL	—	partd_check_drug calculate_optimal_drug_cost() db.py	partd_check_drug calculate_optimal_drug_cost() db.py	—	—
Pharmacy Finder Preferred vs non-preferred	—	find_preferred_pharmacy get_pharmacy_network() chat.py	find_preferred_pharmacy get_pharmacy_network() chat.py	—	—
5️⃣ COST ANALYSIS What will it cost?
Total Cost Calculator Annual cost estimate	partab_get_costs facts.get_costs() facts.yaml	cost_estimate_total get_costs() + calc Plans DB	cost_estimate_total get_costs() + calc Plans DB	cost_estimate_total get_costs() + calc CSG + facts	cost_estimate_total get_costs() + calc CSG API
IRMAA Calculator Income-based surcharges	get_irmaa facts.get_irmaa() facts.yaml	get_irmaa facts.get_irmaa() facts.yaml	get_irmaa facts.get_irmaa() facts.yaml	—	—
6️⃣ FINANCIAL ASSISTANCE Can I get help paying?
Extra Help / LIS Low income drug subsidy	—	check_lis_eligibility check_income_assets() chat.py	check_lis_eligibility check_income_assets() chat.py	—	—
MSP Eligibility QMB, SLMB, QI programs	check_msp_eligibility check_state_msp() chat.py	—	—	—	—
7️⃣ SPECIAL SITUATIONS Edge cases & coordination
Medigap GI Rights Guaranteed issue check	—	—	—	medigap_check_gi check_gi_eligibility() rules.yaml	—
SNP Eligibility D-SNP, C-SNP, I-SNP	—	check_snp_eligibility verify_snp_requirements() chat.py	—	—	—
COB Rules Primary/secondary payer	check_cob_rules determine_payer_order() chat.py	check_cob_rules determine_payer_order() chat.py	check_cob_rules determine_payer_order() chat.py	check_cob_rules determine_payer_order() chat.py	—
8️⃣ ENROLLMENT Take action
Start Enrollment Begin signup process	—	enroll_save save_enrollment() Enrollment DB	enroll_save save_enrollment() Enrollment DB	enroll_save save_enrollment() Enrollment DB	enroll_save save_enrollment() Enrollment DB

🏛️Original: Parts A & B

⭐MA: Medicare Advantage

💊PDP: Part D

🛡️Medigap: Supplement

🦷DVH: Dental/Vision/Hearing

★Real-time: CSG API

🔴Missing: Should build

✅ Coverage Complete

Tools Built

Tools Missing

100%

Coverage

High Priority

📋 Regulatory Compliance

Compliance Requirements Status

Medicare plan marketing requires compliance with CMS, HIPAA, state insurance, and consumer protection regulations.

📝

TPMO Compliance

88%

○Carrier Contracts (Humana, UHC, etc.)

✓AHIP Medicare Certification

✓State Insurance License (CA #4234409)

✓PEWC (N/A - not sharing leads between TPMOs)

✓TPMO Disclaimer (Chat)

✓No Volume-Based Bonuses

✓Fixed Compensation Policy

✓Call Recording (N/A for chat)

🏛️

CMS Marketing

86%

✓SOA (Scope of Appointment)

✓Medicare.gov Disclaimer

✓No Misleading Claims

✓AI Disclosure

✓Human Handoff for Enrollment

✓VA/Medigap Effects Discussion

○Carrier Material Approval

✅

PECL (Pre-Enrollment)

100%

✓Evidence of Coverage Access

✓Network Rules & Restrictions

✓Prior Authorization Info

✓Total Cost Estimates

✓Disenrollment Rights

✓Grievance & Appeals Process

✓Provider Directory

✓Drug Formulary

🏢

State Insurance

100%

✓CA Insurance License (#4234409)

✓NPN Registration (#20445723)

✓E&O Insurance

✓License in Emails (AB 2053)

✓Multi-State Licenses (future expansion)

🔒

HIPAA (Business Associate)

100%

✓Encryption (Transit & Rest)

✓Access Controls (Auth0)

✓Privacy Policy/NPP

✓Data Access Rights

✓Audit Logging

✓BAA with Azure

✓BAA with Backblaze

✓BAA with Google Workspace

✓Security Officer Designation

✓Privacy Officer Designation

✓Risk Assessment (Annual)

✓Incident Response Plan

✓Breach Notification Procedures

✓Workforce HIPAA Training

👤

Privacy & Consumer

100%

✓Privacy Policy

✓Terms of Service

✓CCPA Data Deletion

✓CCPA Data Export

✓Cookie Consent Banner (N/A - self-hosted analytics)

♿

Accessibility

100%

✓WCAG 2.1 AA Audit

✓Screen Reader Testing (Lighthouse passed)

✓65+ User Testing (future)

📄

Policy Documents

100%

✓Business Associate Agreement (Azure)

✓Business Associate Agreement (Backblaze)

✓Business Associate Agreement (Google Workspace)

✓Subprocessor List

✓Information Security Policy

✓Intercompany Services + BAA (B Corp → LLC)

✓B Corp Board Resolution (Security Policies)

✓HIPAA Internal Privacy Policy

✓Incident Response Policy

✓Breach Notification Policy

✓Risk Assessment and Treatment Policy

✓Business Continuity and Disaster Recovery

✓Access Control and Termination Policy

✓Acceptable Use Policy

✓Vendor Management Policy

✓CMS Marketing Compliance Policy

✓TPMO Compliance Documentation

🏢

Corporate Legal Structure

100%

✓Footer: Corporate structure (B Corp + LLC)

✓Trust Center: Corporate structure (footer done, diagram TODO)

✓Privacy Policy: Name LLC as data controller

✓Terms of Service: Contract with LLC entity

ℹ️

Note: TPMO is a regulatory category, not a registration

There is no separate TPMO registration with CMS. Any entity doing Medicare marketing/sales is automatically a TPMO. Requirements: carrier contracts, AHIP certification, state license, compliance with TPMO rules.

🚨 Critical Gaps (Launch Blockers)

✗

Carrier Contracts

Need agreements with Humana, UHC, Aetna, etc.

Overall Compliance:67%|31 of 46 requirements met

// FOR DEVELOPERS

Technical Architecture

Under the hood: FastAPI backend, PostgreSQL on Sota, OpenRouter LLM, Sota Qwen3 embeddings, and 15 specialized tools.


┌─────────────────────────────────────────────────────────────────────────────┐
│                           FRONTEND (Next.js 14)                             │
│                         Vercel / localhost:3000                             │
├─────────────────────────────────────────────────────────────────────────────┤
│  /app/chat         → ChatClient.tsx (real-time SSE streaming)              │
│  /app/how-it-works → Technical documentation                               │
│  /app/api/chat     → Proxy to backend                                      │
│  /components       → PlanCard, DrugCost, ChatMessage, etc.                 │
└──────────────────────────────┬──────────────────────────────────────────────┘
                               │ POST /api/chat (SSE)
                               ▼
┌─────────────────────────────────────────────────────────────────────────────┐
│                        BACKEND (FastAPI + Python)                           │
│                      On-Premises Infrastructure / localhost:8001                     │
├─────────────────────────────────────────────────────────────────────────────┤
│  chat.py ────► Main endpoint, 15 tools, compliance injection               │
│  router.py ──► Question routing (TOOL vs RAG vs REDIRECT)                  │
│  skills.py ──► Skill prompts (plan-finder, cost-calculator, etc.)          │
│  facts.py ───► Single source of truth (accuracy_facts.yaml)                │
│  db.py ──────► Database queries (plans, drugs, providers, RAG)             │
└──────────┬───────────────────┬───────────────────┬──────────────────────────┘
           │                   │                   │
           ▼                   ▼                   ▼
┌──────────────────┐ ┌──────────────────┐ ┌──────────────────┐ ┌──────────────┐
│   Users DB       │ │   Plans DB       │ │   RAG DB         │ │ OpenRouter   │
│   (Local PG)     │ │   (Local PG)     │ │   (pgvector)     │ │   (GPT-4o)   │
├──────────────────┤ ├──────────────────┤ ├──────────────────┤ ├──────────────┤
│ • profiles       │ │ • 8,000+ plans   │ │ • 150K+ pages    │ │ • Chat       │
│ • medications    │ │ • drug formulary │ │ • CMS/Medicare   │ │ • Tools      │
│ • doctors        │ │ • provider ntwk  │ │ • SSA handbook   │ │ • Embeddings │
└──────────────────┘ └──────────────────┘ └──────────────────┘ └──────────────┘

Next.js 14FastAPIPython 3.11PostgreSQLpgvectorOpenRouterQwen3-Embedding-4BVercelCloudflare Tunnel

🗄️ Data Infrastructure

3 Isolated PostgreSQL Databases

PHI isolation, plan data separation, and vector search — each with dedicated connection pools.

🔒

Users DB

unihealth-users

Isolated PHI/PII storage with HIPAA-compliant access controls.

health_records.users

health_records.conversations

health_records.demographics

privacy_requests

📊

Plans DB

unihealth-systems

CMS plan data + CSG cached quotes for fast lookups.

plans.ma_plans (8,000+)

plans.pdp_plans

plans.formulary

csg_medigap_quotes

csg_dvh_quotes

🧠

RAG DB

pgvector

Vector embeddings for semantic Medicare Q&A search.

rag_documents (147K+)

rag_chunks

Qwen3-Embedding-4B (2560-dim)

↔️ Data Flow

User Query→RAG Search→Plans Lookup→LLM Response→Store in Users DB

⚙️ Data Pipeline

Dagster ETL Orchestration

Running on On-Premises Infrastructure

18 automated pipelines process data from 47+ original sources monthly, keeping our Medicare database fresh and accurate.

🏥

MA2 Pipeline — Medicare Advantage Plans

Quarterly • CMS Plan Benefit Package (PBP) Files

📥 Data Sources & Steps

→ cms.gov/Medicare/Prescription-Drug-Coverage/PrescriptionDrugCovGenIn

→ Plan Benefit Package (PBP) Files

→ Benefits Crosswalk & Code Dictionaries

→ OPT (Optional Supplemental) Packages

→ SNP (Special Needs Plan) Data

→ Service Area Files (county-level)

📊 Output Tables

GET /api/plans/summary/{bid_id}plans.ma_*mapdp_human_readable_ma_plansmapdp_plan_informationmapdp_beneficiary_costmapdp_inpatient_snfmapdp_dental

💊

PDP Pipeline — Prescription Drug Plans

Monthly • CMS Part D Files + Formulary Data

📥 Data Sources

→ cms.gov/Medicare/Prescription-Drug-Coverage/PrescriptionDrugCovContra

→ Basic Drugs Formulary File (tiers by rxcui)

→ Pricing Files (NDC-level costs, 18.9M rows)

→ Pharmacy Network Files (preferred/non-preferred)

→ Excluded Drugs & Restrictions (PA/ST/QL)

→ Beneficiary Cost Files (copay/coinsurance)

📊 Output Tables

mapdp_drug_pricing (2.9GB)mapdp_basic_formularymapdp_excluded_drugsmapdp_pharmacy_networks (75GB)mapdp_pharmacy_locationsmapdp_insulin_cost

👨‍⚕️

Provider Hybrid Pipeline — 7M+ NPIs

Monthly • 16 Government Data Sources

📥 Data Sources (16)

✓ NPPES Core (7M NPIs)

✓ Medicare PAR

✓ DAC Utilization

✓ Open Payments (General)

✓ Open Payments (Research)

✓ OIG Exclusions

✓ CMS Opt-Outs

✓ NBER License Crosswalk

✓ NBER Medicaid Crosswalk

✓ Facility Affiliations

✓ MIPS Clinician Measures

✓ MIPS Clinician Scores

✓ MIPS Group Measures

✓ MIPS Virtual Group

✓ MIPS Group CAHPS

✓ Geocoding

📊 Output Tables

mapdp_npi_bid_mapping (37GB)mapdp_provider_specialty_statsmapdp_provider_facility_statsmapdp_provider_state_stats

🏢

Provider Directory Pipeline — 160M+ NPI-BID Mappings

Monthly • FHIR APIs + Carrier Directories

🔗 FHIR API Sources (Public)

UHCpublic-provider-directory.uhc.com/v1/api/fhir

Humanafhir.humana.com/api/Provider-Directory

SCANproviderdirectory.scanhealthplan.com

LA Careuat107.ir4.edifecscloud.com/lac/fhir/pd/R4

Devotedfhir.devoted.com/fhir

AetnaBulk FHIR Export (OAuth)

📥 Additional Carrier Sources (12)

✓ Anthem

✓ Cigna

✓ Wellcare

✓ Molina

✓ Alignment

✓ Blue Shield CA

✓ CCHP

✓ Clever

✓ Astiva

✓ Champion

✓ UCLA Health

✓ Imperial

📊 Output Tables

mapdp_npi_bid_mapping (160M+)carrier_provider_networks

537K unique NPIs • Aetna: 141M • Devoted: 10M • UHC: 608K

⭐

Star Ratings Pipeline — Plan Quality Scores

Annual (October) • CMS Quality Rating System

📥 Data Sources

→ cms.gov/Medicare/Prescription-Drug-Coverage/PrescriptionDrugCovGenIn/PerformanceData

→ Part C & D Star Ratings Data (CSV)

→ Cut Points and Measure-Level Data

→ Disenrollment Reason Codes

📊 Output Tables

mapdp_star_ratingsstar_ratings_summarystar_ratings_domainstar_ratings_disenrollment

Levels: Overall (1-5), Health Plan (HD1-HD5), Drug Plan (DD1-DD4)

📈

Enrollments Pipeline — Plan Membership Data

Monthly • CMS Monthly Enrollment Files

📥 Data Sources

→ cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/MCRAdvPartDEnrolData

→ Monthly MA Enrollment by Plan

→ Monthly PDP Enrollment by Plan

→ State/County Penetration Data

📊 Output Tables

mapdp_monthly_enrollmentsenrollment_by_countyenrollment_trends

Used for plan popularity, market share analysis

🧠

RAG Pipeline — Medicare Knowledge Base

As Needed • Official Government Sources

📥 Data Sources (10 parallel scrapers)

✓ CMS.gov (147K sections)

✓ Medicare.gov guides

✓ SSA.gov handbook

✓ Medicare & You PDF

✓ Coverage decisions

✓ IRA drug pricing

📊 Output Tables

rag_documents (147K+)rag_chunksrag_embeddings

Qwen3-Embedding-4B vectors (2560-dim) in pgvector

📍

Zipcode Pipeline — Geographic Mapping

Annual • USPS + Census Bureau

📥 Data Sources

→ unitedstateszipcodes.org/zip-code-database

→ USPS ZIP Code Database

→ Census Bureau FIPS Codes

→ CMS Service Area Files (SAF)

📊 Output Tables

mapdp_merged_zipcode (389MB)mapdp_plan_county_lookup (638MB)mapdp_geographic_locator

ZIP → County → FIPS → Available Plans

🏷️

HCPCS/CPT Pipeline — Medical Codes

Annual (January 15) • NLM UMLS

📥 Data Sources

→ nlm.nih.gov/research/umls

→ UMLS MRCONSO Release

→ HCPCS Level I (CPT) Codes

→ HCPCS Level II Codes

📊 Output Tables

lookups.hcpcs_cpt_codes

Maps procedure codes to benefit categories for cost lookups

📊

Plan Provider Stats Pipeline — Network Analytics

After Provider Load • Derived/Aggregated

📥 Source Tables

→ mapdp_npi_bid_mapping (37GB)

→ NPPES provider taxonomy codes

→ Facility type classifications

→ Medical school affiliations

📊 Output Tables

mapdp_provider_specialty_statsmapdp_provider_facility_stats (1.9GB)mapdp_provider_state_statsmapdp_provider_med_school_stats

Enables fast "How many cardiologists in Plan X?" queries

47+

Data Sources

135+

GB Total Data

18.9M

Drug Pricing Rows

7M+

Provider NPIs

Active Pipelines

Ready to Experience Smart Medicare Guidance?

Ask any question. Our AI will activate the right capabilities and give you answers in seconds.

Start Chatting→

No signup required • Free to use

How UniHealth Works

From Question to Answer in Seconds

You Ask

AI Understands

Real Data

You Get Answers

Powered by Official Government Sources

What's in Our Knowledge Base

What We Check for Each Plan Type

✅ Coverage Complete

Compliance Requirements Status

TPMO Compliance

CMS Marketing

PECL (Pre-Enrollment)

State Insurance

HIPAA (Business Associate)

Privacy & Consumer

Accessibility

Policy Documents

Corporate Legal Structure

🚨 Critical Gaps (Launch Blockers)

Technical Architecture

3 Isolated PostgreSQL Databases

Users DB

Plans DB

RAG DB

↔️ Data Flow

Dagster ETL Orchestration

MA2 Pipeline — Medicare Advantage Plans

📥 Data Sources & Steps

📊 Output Tables

PDP Pipeline — Prescription Drug Plans

📥 Data Sources

📊 Output Tables

Provider Hybrid Pipeline — 7M+ NPIs

📥 Data Sources (16)

📊 Output Tables

Provider Directory Pipeline — 160M+ NPI-BID Mappings

🔗 FHIR API Sources (Public)

📥 Additional Carrier Sources (12)

📊 Output Tables

Star Ratings Pipeline — Plan Quality Scores

📥 Data Sources

📊 Output Tables

Enrollments Pipeline — Plan Membership Data

📥 Data Sources

📊 Output Tables

RAG Pipeline — Medicare Knowledge Base

📥 Data Sources (10 parallel scrapers)

📊 Output Tables

Zipcode Pipeline — Geographic Mapping

📥 Data Sources

📊 Output Tables

HCPCS/CPT Pipeline — Medical Codes

📥 Data Sources

📊 Output Tables

Plan Provider Stats Pipeline — Network Analytics

📥 Source Tables

📊 Output Tables

Ready to Experience Smart Medicare Guidance?

Important disclosures