Open Data Network

pbp2020

pln_plan_cntrct_service_areas

PLN_BNFT_PKG_CST

PLN_BENE_COST

pln_local_cntrct_service_areas

PLN_TIER_LVL_VAL_LKP

PLN_PLAN_FRMLRY

Contract Year (CY) 2020 Medicare Plan Finder (MPF) Benefit Summary

These files provide a summarized view of the CY 2020 Part C benefits offered by Medicare Advantage, 1876 Cost, and demonstration organizations as displayed on MPF. These files exclude PACE and employer-only plans. While these files may contain more benefits than what is currently displayed on the CY 2020 MPF, they do not represent the entire Plan Benefit Package (PBP) submitted by the plan organization to CMS. The complete PBP data is available at: https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/MCRAdvPartDEnrolData/Benefits-Data.html The Excel file named CY2020_MPF_benefit_summary contains the following columns: Org_Name - Organization marketing name for the contract Contract_ID - CMS-issued contract number Plan_ID - CMS-issued ID for the plan benefit package offered under this contract Segment_ID - CMS-issued ID for the segment under this contract/plan Plan_Type_Desc - Type of plan benefit package Contract_Year - Contract year Category_Name - Benefit category Service_Name - Name of the service Limit_Flag - Indicates whether the plan has placed a cap on the benefit (0, 1, blank) Authorization_Flag - Indicates whether the medical service must be pre-approved by the plan (0, 1, 2, blank) Referral_Flag - Indicates whether a referral is required by the plan for the medical service (0, 1, 2, blank) Network_Description - In-network, out-of-network, or blank (not applicable) Cost_Share - Copayment and/or coinsurance for the benefit Valid Values Limit Flag: 0 - There are no limits. 1 - Limits may apply. Blank - Not applicable. This benefit category or plan type does not ask about limits. Authorization: 0 - Authorization is not required. 1 - Authorization is required. 2 - Not applicable. Blank - Not applicable. This benefit category does not ask about authorization. Referral: 0 - Referral is not required. 1 - Referral is required. 2 - Not applicable. Blank - Not applicable. This benefit category does not ask about referrals. The Excel file named CY2020_MPF_optional_supplemental_benefit_summary contains the following columns: Org_Name - Organization marketing name for the contract Contract_ID - CMS-issued contract number Plan_ID - CMS-issued ID for the plan benefit package offered under this contract Segment_ID - CMS-issued ID for the segment under this contract/plan Plan_Type_Desc - Type of plan benefit package Contract_Year - Contract year Package_Description - CMS-issued identifier for the optional supplemental benefit package Category_Description - Benefit category Type_of_Cost_Sharing - Monthly premium or deductible Cost_Share - Amount for the monthly premium or deductible

pln_cntrct

PLN_BNFT_PKG_SERVICES_XWALK