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