Plan Finder dataset pln_snt_ctgry_cst_shr_xwalk_smry [prod], released on 2021-04-12.

Contract Year (CY) 2021 Medicare Plan Finder (MPF) Benefit Summary

These files provide a summarized view of the CY 2021 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 2021 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 CY2021_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 CY2021_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

Plan Finder dataset PLN_BNFT_SRVC_LKP [prod], released on 2021-04-12.

Plan Finder dataset pln_snt_ctgry_cst_shr_xwalk [prod], released on 2021-04-12.

Contract Year (CY) 2021 Medicare Plan Finder (MPF) Benefit Summary

These files provide a summarized view of the CY 2021 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 2021 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 CY2021_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 CY2021_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

Plan Finder dataset pln_bnft_pkg_xwalk [prod], released on 2021-04-12.

Plan Finder dataset pln_rx_cst_shr_data [prod], released on 2021-04-12.

Plan Finder dataset ibc [prod], released on 2021-04-12.

Plan Finder dataset pln_local_cntrct_service_areas [prod], released on 2021-04-12.

Plan Finder dataset PLN_OPTSUPP_CTGRY_LKP [prod], released on 2021-04-12.