Medicare Part C Plan Payment County Level

$79 / year

This dataset contains information provided by insurance companies regarding average payment per member per month for Medicare Part C Plans by county.

Complexity

Medicare Part C (also called Medicare Advantage Plans) provides coverage for all Medicare services, Medicare Part A and Medicare Part B as well as extra coverage like vision, hearing and dental coverage and is covered by offered by private companies approved by Medicare. The beneficiaries has Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) coverage through the Medicare Advantage Plan (Part C Plans) and not Original Medicare. Medicare pays a fixed amount for your care each month to the companies offering Medicare Advantage Plans.

The Centers for Medicare and Medicaid Services (CMS) conduct Risk Adjustment Factors to pay plans for the risk of the beneficiaries they enroll, instead of calculating an average amount of Medicare/Medicare Advantage beneficiaries. By doing so, CMS is able to make appropriate and accurate payments for enrollees with differences in expected costs. Lastly, the risk adjustment allows CMS to use standardized bids as base payments to plans. CMS risk adjusts certain plan payments, such as Part C payments made to Medicare Advantage plans.

CMS releases summary Part C and Part D payment data after the reconciliation of Part C and Part D payments, as provided in 42 CFR
§422.504(n)(1) and 42 CFR §423.505(o)(1). Additional information on the summary Part C and Part D payment data that CMS releases, can be found in CMS April 15, 2011 final rule, “Medicare Program; Changes to the Medicare Advantage and the Medicare Prescription Drug Benefit Programs for Contract Year 2012 and Other Changes,” published in the Federal Register at 76 FR 21432. The categories of data are expressed at a summary level only. In addition, in instances where the level of aggregation identified in a data category was determined to be potentially insufficient to provide adequate protection against any disaggregation, such data is not included in said category. Any risk-adjusted payment is standardized to a 1.0 risk score, meaning that the included numbers are equal to the average risk-adjusted amount divided by the average risk score.

Date Created

2012-02-23

Last Modified

2017-01-21

Version

2017-01-21

Update Frequency

Semiannual

Temporal Coverage

2015

Spatial Coverage

United States

Source

John Snow Labs => Centers for Medicare and Medicaid Services

Source License URL

John Snow Labs Standard License

Source License Requirements

N/A

Source Citation

N/A

Keywords

Medicare Part C Payments, Medicare Part C Plans, Medicaid Plan C, Medicare by County Data, County

Other Titles

Average Per Member Per Month Payment, Health Insurance Payment, Medicare Advantage Plans, Medicare Part C Payment by County

Name Description Type Constraints
County_CodeCode of county on which the insurance plan type details are providedstring-
State_AbbreviationState abbreviation on which the insurance plan type details are providedstring-
County_LocationName of county on which the insurance plan type details are providedstring-
Plan_TypeType of insurance plan specification or requirements. Different plan types offer a Local HMO (health maintenance organization), Local PPO (Local Preferred Provider Organizations Plans), MSA (medical savings account), PFFS (Private Fee-For-Service) or a Regional PPO (Regional Preferred Provider Organizations Plans)string-
SNP_Plan_TypeMedicare Special Needs Plans are a type of Medicare Advantage Plan (like an HMO or PPO). Medicare SNPs limit membership to people with specific diseases or characteristicsstring-
Average_Part_Risk_ScoreAverage health risk score of the beneficiary is used to calculate the insurance premiums or payments of different plan typesnumberlevel : Ratio
Average_AB_PMPM_Payment_USDAverage Part A and Part B per member per month payment that need to be done by the beneficiary for a particular plannumberlevel : Ratio
Average_Rebate_PMPM_Payment_USDAverage rebate per member per month payment for a particular plannumberlevel : Ratio
County_CodeState_AbbreviationCounty_LocationPlan_TypeSNP_Plan_TypeAverage_Part_Risk_ScoreAverage_AB_PMPM_Payment_USDAverage_Rebate_PMPM_Payment_USD
55310HMO0.68735.1371.26
55330HMO0.58706.0989.12
55810HMO0.44695.5789.89
55830HMO0.70657.7794.01
57430HMO0.61669.9082.61
57980HMO0.60740.0078.75
58110HMO0.83707.2363.31
58130HMO0.81754.1866.91
58270HMO0.66721.8253.70
61000HMO0.77690.1697.32