Medicare Plan

Medicare Plan Listing

Medicare plan listing stores the details of all the US Medicare Advantage (MA) and Prescription Drug Plans (PDP) offered by the health plan.

CMS contract number: Centers for Medicare and Medicaid services (CMS) contract number.
Plan benefit package ID: Three-digit PBP identifier of the plan.
Segment ID: Segment identifier of the plan.
Organization name: Legal entity name of the organization.
Plan name: Plan name as it appears in HPMS and is filed in the BID with CMS.
Plan short name: Shortened plan name as that used in paper enrollment forms.
Plan type: Type of the plan. That is a Medicare Advantage or Medicare Advantage prescription drug, etc.
Network type: Network type, for example: Health maintenance organization (HMO), local preferred provider organizations (PPO), regional PPO etc.
Employer group plan?: Is this plan an employer-group Medicare plan?
Part B only plan?: Does this plan provide Medicare Advantage coverage for members with only Medicare Part B and not Part A?
Region number: Region number, as covered by the regional PPO or PDP
OSB offered?: Are OSB offered under this contract PBP or contract PBP segment?
SNP plan?: Is this a special needs plan?
SNP plan type: Special needs plan type.
VBID chronic conditions?: Is this a value-based insurance design plan for the chronically ill?
VBID hospice?: Is this a value-based insurance design plan for hospice members?
DE MINIMIS?: Does this plan waive the de minimis amount above the LIS benchmark for PDP members with LIS subsidy?
Total premium part C: Total Part C premium, including any mandatory supplemental benefits premium and after application of rebate amounts.
Total premium part D: Total Part D premium, including basic and supplemental benefit premiums and after application of rebate amounts and excluding LIS or SPAP subsidy or LEP amount.
Total premium: Total of part C and part D premiums, inclusive of all mandatory supplemental benefits and post application of rebate amounts and excluding LIS or SPAP subsidy or LEP amount.
Medicare C-SNP plan condition: List of Medicare plan C-SNP conditions.
Start date: The effective date of the Medicare product.
End date: The end date of the Medicare product.

Constraints:

An overlap in time validity is not allowed for Medicare plan listings with the same CMS contract number, plan benefit package ID, and segment ID.

This entity is used for informational purposes only and does not impact premium calculations.

Plan Type

The possible values for plan type are:

Table 1. Plan Type
Plan Type	Description
MA	Medicare advantage
MAPD	Medicare advantage prescription drug plan
PDP	Prescription Drug plan

Network Type

The possible values for network type are:

Table 2. Network Type
01	HMO
02	HMOPOS
04	Local PPO
05	PSO (state license)
07	MSA
08	RFB PFFS
09	PFFS
18	1876 cost
19	HCPP 1833 cost
20	National PACE
28	Chronic care
29	Medicare prescription drug plan
30	Employer/union only direct contract PDP
31	Regional PPO
40	Employer/Union only direct contract PFFS
42	RFB HMO
43	RFB HMOPOS
44	RFB local PPO
45	RFB PSO (state license)
46	Point of sale contractor
47	Employer/union only direct contract PPO
48	Medicare-Medicaid plan HMO
49	Medicare-Medicaid plan HMOPOS
50	Medicare-Medicaid plan PPO

SNP Plan Type

The possible values for SNP Plan Type are:

Table 3. SNP Plan Type
SNP Plan Type	Description
D	Dual SNP
C	Chronic condition SNP
I	Institutional SNP

Medicare Plan C-SNP Plan Conditions

List of possible C-SNP plan conditions associated with a Medicare Plan

Medicare Plan Listing: Reference to the Medicare plan listing
CSNP Condition: Type of the chronic condition

C-SNP Conditions

The possible values for the C-SNP condition type are:

Table 4. C-SNP Condition Type
C-SNP Condition Type	Description
Chronic alcohol	Chronic alcohol and other drug dependence
Autoimmune	Autoimmune disorders
Cancer	Cancer, excluding pre-cancer conditions or in-situ status
Cardiovascular	Cardiovascular disorders
Chronic heart	Chronic heart failure
Dementia	Dementia
Diabetes	Diabetes mellitus
End stage liver	End-stage liver disease
End stage renal	End-stage renal disease (ESRD) requiring dialysis
Hematologic	Severe hematologic disorders
HIV	HIV or AIDS
Chronic lung	Chronic lung disorders
Chronic mental Health	Chronic and disabling mental health conditions
Neurologic	Neurologic disorders
Stroke	Stroke