Medicare Advantage Rates And Statistics

**Overview**
This data package contains the data package includes all datasets released by the Centers for Medicare and Medicaid Services (CMS) that belong to the category of Ratebooks & Supporting Data for Medicare Advantage Plan costs estimation. The data contained are related to the two components of the capitated payment (rates and risk scores) and to the county and regional statutory benchmark.

**Description**
This data package contains for the years after 2004, the Secretary of Health and Human Services is required to recalculate 100 percent of the fee-for-service Medicare costs at least every three years – so that at least every three years the Medicare Advantage (MA) capitation rate will be the higher of the fee-for-service rate and the minimum increase rate. Health plans that participate in the Medicare Advantage program receive monthly capitation payments for each Medicare enrollee. Each capitated payment is the product of two general parts: 1) A base rate which reflects the payment if a Medicare Advantage enrollee has the health status of the national average beneficiary, and 2) A risk score which indicates how costly the enrollee is expected to be relative to the national average beneficiary. The purpose of the risk scores is to adjust Medicare Advantage payments so that they accurately reflect how much each Medicare Advantage enrollee would be expected to cost.

CMS has implemented a number of changes in the Medicare Advantage payment methodology beginning in Fiscal Year 2012 as a result of payment changes enacted in the Affordable Care Act, including 1) a new blended benchmark as the county rate, 2) the new methodology used to derive the new blended benchmark county rates, 3) identify the qualifying bonus counties, 4) how to determine transitional phase-in periods, and 5) the applicability of the star system in the rebates. At the same time the key components of the current Medicare Advantage rates include 1) Revision to the risk-adjustment model to better account for fully dual eligible beneficiaries. 2) Adjustment to certain measures within the Star Ratings program for socioeconomic status. 3) Update to the blended risk scores using a percent of the risk score calculated using data from the Risk Adjustment Processing System (RAPS) and the remaining percent of the risk score calculated using encounter data. 4) Incentives to Medicare Advantage organizations to offer plans with lower maximum out-of-pocket limits.

**Benefits**
- Useful for medicare advantage plan stakeholders and public health specialist or specialized public. the user can utilize the datasets as they are, without further cleaning of data. the fields descriptions along with the dataset description are useful for the user to quickly understand the data and the dataset.

**License Information**
The use of John Snow Labs datasets is free for personal and research purposes. For commercial use please subscribe to the [Data Library](https://www.johnsnowlabs.com/marketplace/) on John Snow Labs website. The subscription will allow you to use all John Snow Labs datasets and data packages for commercial purposes.

**Included Datasets**
- [Insurance Coverage of Noninstitutionalized Medicare Beneficiaries](https://www.johnsnowlabs.com/marketplace/insurance-coverage-of-noninstitutionalized-medicare-beneficiaries)
- The Insurance Coverage of Noninstitutionalized Medicare Beneficiaries dataset includes data about Medicare insurance coverage beneficiaries aged 65 in the United States by age, gender, race, poverty and marital status between 1992 and 2015.
- [Medicare Advantage ESRD Risk Score Dialysis](https://www.johnsnowlabs.com/marketplace/medicare-advantage-esrd-risk-score-dialysis)
- The dataset Medicare Advantage End-Stage Renal Disease (ESRD) Risk Score Dialysis deals with Medicare payment rates for 2016-2020. ESRD Dialysis Risk Scores used in the ratebooks are calculated using the model to be used in the payment year. The beneficiaries included in the state-level risk scores in this dataset are those enrolled in fee-for-service (FFS) population, who were not in hospice.
- [Medicare Advantage Non PACE Risk Score by County](https://www.johnsnowlabs.com/marketplace/medicare-advantage-non-pace-risk-score-by-county)
- The dataset contains information on the non-PACE (Programs of All-Inclusive Care for the Elderly) risk scores 2016-2020. Risk scores used in the ratebooks are calculated using the model to be used in the payment year. The beneficiaries included in the state-level risk scores in this dataset are those enrolled in fee-for-service (FFS) population.
- [Medicare Advantage PACE Risk Score By County](https://www.johnsnowlabs.com/marketplace/medicare-advantage-pace-risk-score-by-county)
- The dataset contains information on the Program of All-Inclusive Care for the Elderly (PACE) Risk Scores 2016-2020. Risk scores used in the ratebooks are calculated using the model to be used in the payment year. The beneficiaries included in the county-level risk scores in this dataset are those enrolled in fee-for-service (FFS) population, who do not have end-stage renal disease (ESRD) and who were not in hospice.
- [Medicare Advantage Rate Statutory Benchmark By Region And County](https://www.johnsnowlabs.com/marketplace/medicare-advantage-rate-statutory-benchmark-by-region-and-county)
- The dataset contains information on the statutory and plan-bid components of the regional and county Medicare Advantage (MA) benchmarks for the year 2023. The patient population that chooses MA includes individuals with a wide variation in health and disease status.
- [Medicare Advantage Risk Rate For All Plans Except PACE](https://www.johnsnowlabs.com/marketplace/medicare-advantage-risk-rate-for-all-plans-except-pace)
- This dataset contains information on Medicare Advantage (MA) risk rates for all plans except Program of All-Inclusive Care for the Elderly (PACE) plans. Health plans that participate in the MA program receive monthly capitation payments for each Medicare enrollee.
- [Medicare Advantage Risk Rates For PACE Plans](https://www.johnsnowlabs.com/marketplace/medicare-advantage-risk-rates-for-pace-plans)
- This dataset contains information on Medicare Advantage (MA) risk rates for Program of All-Inclusive Care for the Elderly (PACE) plans. Health plans that participate in the MA program receive monthly capitation payments for each Medicare enrollee.
- [Medicare Population End Stage Renal Disease Rate Dialysis](https://www.johnsnowlabs.com/marketplace/medicare-population-end-stage-renal-disease-rate-dialysis)
- The dataset Medicare End-Stage Renal Disease (ESRD) Rate Dialysis deals with Medicare payment rates for dialysis for 2023.
- [Noninstitutionalized Population Data Without Health Insurance Coverage](https://www.johnsnowlabs.com/marketplace/noninstitutionalized-population-data-without-health-insurance-coverage)
- This dataset includes information regarding civilian noninstitutionalized population without health Insurance coverage for persons under the age of 65 years in the United States and Puerto Rico by territory, state and age from year 2009 through 2016.

**Data Engineering Overview**
**We deliver high-quality data**
- Each dataset goes through 3 levels of quality review
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**Our data is curated and enriched by domain experts**

Each dataset is manually curated by our team of doctors, pharmacists, public health & medical billing experts:
- Field names, descriptions, and normalized values are chosen by people who actually understand their meaning
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