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This variable is the Medicare Part C contract number for the beneficiary’s Medicare Advantage (MA) plan for a given month (May).
CMS assigns an identifier to each contract that a managed care plan has with CMS.
This variable is the Medicare Part C contract number for the beneficiary’s Medicare Advantage (MA) plan for a given month (November).
CMS assigns an identifier to each contract that a managed care plan has with CMS.
This variable is the Medicare Part C contract number for the beneficiary’s Medicare Advantage (MA) plan for a given month (October).
CMS assigns an identifier to each contract that a managed care plan has with CMS.
This variable is the Medicare Part C contract number for the beneficiary’s Medicare Advantage (MA) plan for a given month (September).
CMS assigns an identifier to each contract that a managed care plan has with CMS.
The variable is the Medicare Part C plan benefit package (PBP) for the beneficiary’s Medicare Advantage (MA) plan for a given month (April).
CMS assigns an identifier to each PBP within a contract that a Part C plan sponsor has with CMS.
The variable is the Medicare Part C plan benefit package (PBP) for the beneficiary’s Medicare Advantage (MA) plan for a given month (August).
CMS assigns an identifier to each PBP within a contract that a Part C plan sponsor has with CMS.
The variable is the Medicare Part C plan benefit package (PBP) for the beneficiary’s Medicare Advantage (MA) plan for a given month (December).
CMS assigns an identifier to each PBP within a contract that a Part C plan sponsor has with CMS.
The variable is the Medicare Part C plan benefit package (PBP) for the beneficiary’s Medicare Advantage (MA) plan for a given month (February).
CMS assigns an identifier to each PBP within a contract that a Part C plan sponsor has with CMS.
The variable is the Medicare Part C plan benefit package (PBP) for the beneficiary’s Medicare Advantage (MA) plan for a given month (January).
CMS assigns an identifier to each PBP within a contract that a Part C plan sponsor has with CMS.
The variable is the Medicare Part C plan benefit package (PBP) for the beneficiary’s Medicare Advantage (MA) plan for a given month (July).
CMS assigns an identifier to each PBP within a contract that a Part C plan sponsor has with CMS.
The variable is the Medicare Part C plan benefit package (PBP) for the beneficiary’s Medicare Advantage (MA) plan for a given month (June).
CMS assigns an identifier to each PBP within a contract that a Part C plan sponsor has with CMS.
The variable is the Medicare Part C plan benefit package (PBP) for the beneficiary’s Medicare Advantage (MA) plan for a given month (March).
CMS assigns an identifier to each PBP within a contract that a Part C plan sponsor has with CMS.
The variable is the Medicare Part C plan benefit package (PBP) for the beneficiary’s Medicare Advantage (MA) plan for a given month (May).
CMS assigns an identifier to each PBP within a contract that a Part C plan sponsor has with CMS.
The variable is the Medicare Part C plan benefit package (PBP) for the beneficiary’s Medicare Advantage (MA) plan for a given month (November).
CMS assigns an identifier to each PBP within a contract that a Part C plan sponsor has with CMS.
The variable is the Medicare Part C plan benefit package (PBP) for the beneficiary’s Medicare Advantage (MA) plan for a given month (October).
CMS assigns an identifier to each PBP within a contract that a Part C plan sponsor has with CMS.
The variable is the Medicare Part C plan benefit package (PBP) for the beneficiary’s Medicare Advantage (MA) plan for a given month (September).
CMS assigns an identifier to each PBP within a contract that a Part C plan sponsor has with CMS.
This variable is the type of Medicare Part C plan for the beneficiary for a given month (April).
This variable is the type of Medicare Part C plan for the beneficiary for a given month (August).
This variable is the type of Medicare Part C plan for the beneficiary for a given month (December).
This variable is the type of Medicare Part C plan for the beneficiary for a given month (February).
This variable is the type of Medicare Part C plan for the beneficiary for a given month (January).
This variable is the type of Medicare Part C plan for the beneficiary for a given month (July).
This variable is the type of Medicare Part C plan for the beneficiary for a given month (June).
This variable is the type of Medicare Part C plan for the beneficiary for a given month (March).
This variable is the type of Medicare Part C plan for the beneficiary for a given month (May).
This variable is the type of Medicare Part C plan for the beneficiary for a given month (November).
This variable is the type of Medicare Part C plan for the beneficiary for a given month (October).
This variable is the type of Medicare Part C plan for the beneficiary for a given month (September).
This variable is the dollar amount of the Medicare Advantage (referred to as Medicare Part C) Basic Plus Mandatory Supplemental Premium Rate (Net of Rebates).
This variable is the dollar amount of the Part D Basic Premium. This amount is net of any Part A/B rebates applied to "buy down" the drug premium for Medicare Advantage plans.
This variable is the dollar amount that the beneficiary paid for all PDEs for a given year, without being reimbursed by a third party. The amount includes all copayments, coinsurance, deductible, or other patient payment amounts, and comes directly from the source Prescription Drug Events (PDEs).
The total beneficiary payments are calculated as the sum of three CCW variables: patient pay amount (PTNT_PAY_AMT), other troop amount (OTHER_TROOP_AMT), and patient liability reduction due to other payer amount (PLRO_AMT) for Part D drugs for the relevant PDEs.
The encrypted unique number CMS assigns to each contract that a Part D plan has with CMS.
This variable is the Medicare Part D contract number for the beneficiary’s Medicare Part D plan.
CMS assigns an identifier to each contract that a Part D plan has with CMS.
This variable indicates whether the requirement that Part D beneficiaries be entitled to Medicare Part A is waived. The value will indicate whether beneficiaries with only Part B entitlement may enroll in the Part D plan benefit package.
This variable is the dollar amount of Part D deductible charged by the plan.
This variable is the coinsurance percentage beneficiaries are charged by for enhanced alternative plans that offer cost sharing during the deductible phase.
This variable is the dollar amount of Part D beneficiary co-payment charged by enhanced alternative plans that offer cost sharing during the deductible phase.
If beneficiaries who are eligible for Medicare and Medicaid (often called full benefit dual eligibles) enroll in Part D plans with premiums higher than the regional benchmark, they are responsible for paying the premium amount above the benchmark. The benchmark is a statutorily defined amount that is based on the average premium amounts for Part D plans for each region (varies by year).
This variable indicates whether the Part D sponsor has voluntarily waived the portion of the monthly adjusted basic beneficiary premium that is a de minimis amount above the low-income subsidy (LIS) premium benchmark for subsidy-eligible individuals.
LIS individuals who enroll in plans that waive the de minimis premium amount are charged a monthly beneficiary premium for basic prescription drug coverage rather than for the higher de minimis amount (i.e., full benefit dual eligible beneficiaries have a full premium subsidy and would essentially have $0 premium payment).
This variable describes the type of Part D demonstration organization for applicable contracts.
This variable describes the class of pharmacy that filled the prescription. The dispenser class code is self-designated by pharmacies to NCPDP and is not related to taxonomy codes.
Indicates the type of Part D benefit structure used by the plan benefit package (Defined Standard, Actuarially Equivalent, Basic Alternative, or Enhanced Alternative).
Number of months of Part D eligibility (BENE_PTD_STUS_CD not null) in the Performance Year; values from 0-12. For ACOS with Preliminary Prospective Assignment with Retrospective Reconciliation, this value is based on the 12 months in the assignment window; values can range from 0 to 12. For Prospective Assignment ACOs, the maximum number of months for Q1 = 3; Q2 = 6; Q3 = 9; Q4 and Final = 12.
This variable is the Medicare Part D Enrollment Transaction Audit Sequence Number. The number indicates whether the occurrence has been audited. It will default to 0 (zero) for valid occurrences and will be incremented by 1 for audited rows with the same key fields.
This variable is the count of events for Part D drugs for a given year (i.e., a unique count of the PDE_IDs). An event is a dispensed (filled) drug prescription that appears in the Prescription Drug Event (PDE) file.
This variable is the unique identification number assigned to each formulary. Part D plans submit their formularies to CMS and identify the drug products that are covered using the National Library of Medicine’s RxNorm Concept Unique Identifiers (RXCUIs).
This field is a key that links of Part D sponsor's formulary file to their contract and plan identifiers.
Dollar amount of Initial Coverage Limit (ICL) applied by Part D plan. If no ICL is applied this field is blank.
This variable is the dollar amount of the monthly Part D low-income total premium subsidy (LIPS) for beneficiaries at the 100% subsidized level.
This variable is the dollar amount of the monthly Part D low-income total premium subsidy (LIPS) for beneficiaries at the 25% subsidized level.