# PBP hearing (cleaned view)

`medicare_semantic.vw_pbp_hearing` · Medicare Advantage, Part D, Medicaid · status live

Cleaned source-faithful PBP hearing rows: era-normalized, CMS codes decoded, with offered_status/numeric_amount_observability/null_amount_reason/annualization_policy/combined_limit_policy/confidence_tier. The agent reasoning surface for hea

**Grain.** One row per (contract_id, plan_id, segment_id, report_year, quarter, hearing_sub_benefit) — i.e., one row per MA plan-segment, per benefit year, per CMS PBP PUF release-quarter, per hearing sub-benefit (routine exam, aid fitting/eval, Rx hearing aid by ear-type, OTC aid, batteries). This 6-column set is VERIFIED unique and minimal: it yields exactly 632,961 distinct combinations = the full row_count of 632,961, and dropping ANY one of the six breaks uniqueness (e.g. dropping quarter collapses to 366,850, dropping hearing_sub_benefit to 201,488). source_pbp_section is redundant given hearing_sub_benefit; version is functionally determined by the grain (every grain row has exactly 1 version) and is NOT a key.

**How to use it.** Get current MA hearing-aid allowances for 2026: SELECT contract_id, plan_id, segment_id, benefit_amount, benefit_amount_period_label, benefit_amount_annualized, hearing_cap_per_ear_label FROM medicare_semantic.vw_pbp_hearing WHERE report_year=2026 AND quarter=1 AND hearing_sub_benefit='prescription_hearing_aids_all_types' AND hearing_offered AND normalization_status='normalized'. Answers 'what dollar amount does each MA plan allow toward prescription hearing aids this year, and over what period'. (Pin a single quarter to avoid the ~4x quarterly-snapshot duplication; gate normalization_status='normalized' to get real dollar allowances; read hearing_cap_per_ear_label before comparing the dollars.)

**Traps.**
- quarter is the CMS RELEASE quarter, not a coverage quarter. The same plan-year benefit is stored once PER quarterly re-publication, so a benefit identical all year appears as up to 4 near-duplicate rows that differ ONLY by quarter (verified: a 4-row group was byte-identical except quarter=1,2,3,4). There is NO is_current/is_latest column. To get one row per plan, pick a single (report_year, quarter) — e.g. the MAX(quarter) available for that year — before aggregating, or you will multiply-count plans by ~4x.
- version looks like a key but is NOT: it is functionally determined by the grain (exactly 1 version per grain row) and the view already selects the applicable version. A single quarter shows 16-22 distinct version values only because different plans have different amendment counts. Never join on version or add it to a dedup key.
- benefit_amount (plan dollar ALLOWANCE, e.g. $5,000 toward aids) and copay_amount/coinsurance_pct (member COST-SHARE, e.g. $50 exam copay) are two different economic concepts that mostly populate on different rows (allowance on B18B aids, copay on B18A exams). benefit_amount is NULL unless normalization_status='normalized' (~78k of 633k rows); a NULL is meaningful (see null_amount_reason: 'combined_limit_elsewhere' / 'not_offered'), not missing data. Also do NOT sum benefit_amount across a plan's hearing sub-benefits — aggregation_policy='component_or_shared_cap_do_not_sum' warns the cap may be shared. And ALWAYS read hearing_cap_per_ear_label before comparing allowances ('per ear' vs 'both ears combined' changes the effective dollar by ~2x).
- The two B18A sub-benefits routine_hearing_exam and hearing_aid_fitting_evaluation are a deterministic FAN-OUT of one source row (identical 201,488 counts, same source column, same offered/copay). They are not independent benefits — counting both double-counts B18A. Likewise replacement_batteries exists ONLY in report_year 2001 (vestigial) and otc_hearing_aids / section B18C only from 2025 onward (the OTC regulatory change), so sub-benefit availability is era-dependent.
- Many columns are DEGENERATE constants for the entire hearing view and carry zero filtering power: benefit_category='hearing', network_type='in_network', benefit_amount_kind='maximum_plan_benefit', normalization_basis='cms_periodicity_code', aggregation_policy, combined_limit_policy, consumer_document_reconciliation_status='not_checked', confidence_tier='source_faithful', source_silver_table, and lmi_authorities=''. Do not filter on them expecting variation. Conversely, NULLs in auth_required/referral_required/max_oop_applies mean 'unknown/not captured here' (raw auth lives in hearing_auth_raw), and hearing_offered_code can be NULL while hearing_offered_label='Yes' (3,803 derived OTC rows) — prefer the boolean hearing_offered as the clean coverage flag.

| column | type | meaning |
|---|---|---|
| contract_id | string | CMS MA contract ID (e.g. H0150). 1,972 distinct. Part of grain. Join key to plan/enrollment tables. |
| plan_id | string | Plan ID within the contract (e.g. 001). 656 distinct values but NOT unique on its own. Part of grain. |
| segment_id | string | Plan segment (service-area split). Often empty string '' for pre-~2018 years and '0' later; 27 distinct. Part of grain — do NOT drop it (dropping it collapses 632,961→602,837). |
| version | double | CMS bid/PUF version number for that plan within the release-quarter (1..22+). Functionally determined by the grain (exactly 1 version per grain row) — the view already picks the applicable version, so it is a snapshot tag, NOT a join key or grain dimension. Higher version counts in a quarter just reflect how many plans had that many amendments. |
| report_year | double | Benefit/contract year the row describes (2001-2026). The primary time dimension (the profiler mislabels 'quarter' as the time column — use report_year). |
| quarter | double | CMS PBP PUF RELEASE quarter (1-4) within report_year — which quarterly re-publication this snapshot came from, NOT a quarter of coverage. Mature years have all of 1-4; 2025/2026 currently only quarter 1. Part of grain because each quarterly release is retained as a separate row even when the benefit is identical across quarters. |
| benefit_category | string | Constant literal 'hearing' for the whole view (this is the hearing slice of a broader PBP family of views). |
| cost_share_string | string | Human-readable member cost-share, e.g. '$15.0 copay'. NULL when not offered or amount not specified. Parsed into copay_amount/coinsurance_pct. |
| copay_amount | double | Member fixed-dollar copay to use the benefit (e.g. $50 for a routine hearing exam). Populated mainly for B18A exams. NULL for not_offered rows and for most aid rows that use an allowance instead. |
| coinsurance_pct | double | Member coinsurance percentage (rare — only ~2,219 rows). NULL otherwise. |
| limit_text | string | Raw frequency-limit text, e.g. '1.0 exams/3' (1 exam every 3rd period). Parsed into limit_quantity/limit_unit/limit_period_code. NULL when no limit specified. |
| auth_required | boolean | Prior-authorization required flag. Largely NULL in this view (raw auth captured in hearing_auth_raw instead); treat NULL as unknown. |
| referral_required | boolean | Referral-required flag. Largely NULL — unknown rather than false. |
| network_type | varchar(10) | DEGENERATE: constant 'in_network' for all 632,961 rows. This view carries only in-network terms. |
| max_oop_applies | boolean | Whether benefit counts toward MOOP. Largely NULL (unknown). |
| limit_quantity | double | Numeric quantity of the frequency limit (e.g. 1.0 exams). NULL when no limit. |
| limit_unit | string | Unit of the limit, e.g. 'exams', 'aids'. NULL when no limit. |
| limit_period_code | string | CMS periodicity code for the limit (e.g. '3'). Decoded by limit_period_label. NULL when no limit. |
| limit_period_label | string | Decoded limit period: 'Every year','Every three years','Every two years','Other, Describe', etc. NULL ~346,877 rows (no frequency limit captured). |
| limit_quantity_per_year | double | Limit quantity normalized to a per-year basis (e.g. 1 exam/3yr is still stored; per-year derivation). NULL when not numeric/no limit. |
| benefit_amount | double | The PLAN DOLLAR ALLOWANCE/CAP toward the benefit (kind = maximum_plan_benefit), e.g. $5,000 toward hearing aids. This is the coverage allowance, NOT member cost-share. Populated only when normalization_status='normalized' (~78k rows, mostly B18B aids); NULL otherwise (exams typically use copay instead). |
| benefit_amount_kind | string | DEGENERATE: constant 'maximum_plan_benefit' — benefit_amount is always a max plan allowance, never a deductible/other kind. |
| benefit_amount_period_code | string | CMS periodicity code for the allowance period. NULL when no allowance. |
| benefit_amount_period_label | string | Decoded allowance period: 'Every year','Every two years','Every three years', etc. NULL when no dollar allowance (~554,532). |
| benefit_amount_annualized | double | benefit_amount normalized to an annual figure (e.g. $5,000/2yr → $2,500/yr). Use this to compare allowances across plans with different cap periods. NULL when no allowance. |
| benefit_amount_pmpm | double | Per-member-per-month dollarization of the allowance. Essentially always NULL in this view. |
| normalization_status | varchar(24) | How the amount was normalized: 'normalized' (~78k, has a real benefit_amount), 'frequency_only_no_amount' (~234k, offered with a limit but no dollar amount), or 'not_populated' (~320k). Gate on ='normalized' when you need a dollar allowance. |
| normalization_basis | varchar(43) | DEGENERATE: constant 'cms_periodicity_code' — period normalization is driven by CMS periodicity codes. |
| aggregation_policy | varchar(60) | DEGENERATE: constant 'component_or_shared_cap_do_not_sum' — a WARNING flag: hearing components (exam vs fitting vs aid) may share a cap, so do NOT sum benefit_amount across the sub-benefit rows of one plan. |
| offered_status | varchar(15) | 'offered' (387,680), 'not_offered' (205,787), or 'offered_unknown' (39,494). Mirrors hearing_offered. For not_offered rows all cost-share is NULL/zero; for offered_unknown nothing is populated. |
| numeric_amount_observability | varchar(31) | Why amounts are/aren't present: 'offered_without_numeric_amounts' (~351k), 'not_offered' (~206k), 'all_offered_numeric' (~76k, has benefit_amount). |
| null_amount_reason | string | Why benefit_amount is NULL: 'combined_limit_elsewhere' (shared cap, ~351k), 'not_offered' (~206k), or 'not_null_numeric_amount' (~76k = amount IS present). A NULL amount here is meaningful, not missing data. |
| annualization_policy | varchar(17) | 'not_numeric' (~557k) or 'annualized_safe' (~76k, the annualized fields are trustworthy). |
| combined_limit_policy | varchar(29) | DEGENERATE: constant 'shared_across_components' — limits/caps are shared across the hearing components. |
| consumer_document_reconciliation_status | varchar(11) | DEGENERATE: constant 'not_checked' — these benefits have not been reconciled against consumer-facing plan documents. |
| confidence_tier | varchar(23) | DEGENERATE: constant 'source_faithful' — every row is a faithful transcription of the CMS source (no inference/imputation tier present). |
| coinsurance_pct_max | double |  |
| copay_amount_max | double |  |
| cost_share_populated_in_bid | boolean | Boolean: whether the cost-share fields were populated in the underlying bid. Helps distinguish a true $0/no-copay from a blank source. |
| cost_share_zero_reason | string |  |
| hearing_aid_value_form | string |  |
| hearing_amount_source | string |  |
| hearing_auth_raw | string | Raw CMS auth indicator string, e.g. '00001','01000' (pre-2018 multi-select bitfield) — preserved verbatim; see hearing_auth_source_status for how to read it. |
| hearing_auth_source_status | varchar(43) | How to interpret hearing_auth_raw: 'pre_2018_multiselect_or_post_2018_binary_12' (~618k) vs 'post_2025_binary_12' (~15k, OTC). Code semantics changed across eras — do not compare raw auth strings across this boundary. |
| hearing_benefit_family | string | High-level family: 'hearing_exam', 'prescription_hearing_aid', 'otc_hearing_aid', 'hearing_aid_accessory'. Coarser than hearing_sub_benefit. |
| hearing_benefit_type_code | string | CMS benefit-type code: 1=Additional, 2=Mandatory, 3=Optional, 4=Both. NULL (~293k) where the source did not classify (e.g. older/exam rows). Decoded by hearing_benefit_type_label. |
| hearing_benefit_type_label | string | Decoded benefit type: 'Mandatory'(327k),'Optional','Additional','Both'. NULL ~293k. ('Mandatory' = basic/required supplemental, 'Optional' = buy-up). |
| hearing_cap_network_scope | string |  |
| hearing_cap_per_ear_code | string | How the dollar cap is scoped per ear: 1=Per ear, 2=One single ear, 3=Both ears combined. NULL (~579k) when no cap. Decoded by hearing_cap_per_ear_label. |
| hearing_cap_per_ear_label | string | Decoded cap scope: 'Both ears combined','Per ear','One single ear'. NULL when no cap. CRITICAL for interpreting benefit_amount (a $2,000 'per ear' cap ≈ $4,000/both). |
| hearing_cap_present | boolean | Boolean: whether a dollar cap exists for this benefit. |
| hearing_cap_reference_code | string | What the cap references: 1=Covered under Hearing Exams Category 18a, 2=Plan-specified amount per period. NULL (~561k) when no cap. |
| hearing_cap_reference_label | string | Decoded cap reference: 'Plan-specified amount per period' (most), 'Covered under Hearing Exams Category - 18a'. NULL when no cap. |
| hearing_cap_source | varchar(37) | Which category the cap is sourced from: 'hearing_exam_category_cap' (B18A), 'prescription_hearing_aid_category_cap' (B18B), 'otc_hearing_aid_cap' (B18C). Tracks the section the cap belongs to. |
| hearing_limit_unlimited | boolean | Boolean: benefit is explicitly unlimited (no frequency cap). True ~53k. |
| hearing_limit_unlimited_code | string | CMS code 1=Yes(unlimited)/2=No. NULL (~293k) where not specified. Decoded by hearing_limit_unlimited_label. |
| hearing_limit_unlimited_label | string | 'Yes'/'No' (unlimited?). NULL where not specified. |
| hearing_offered | boolean | Boolean: is this hearing sub-benefit offered by the plan. True(387,680)/False(205,787)/NULL(39,494=unknown). The primary 'is it covered' flag. |
| hearing_offered_code | string | Raw CMS offered code 1=Yes/2=No. NULL ~43,297. NOTE: can be NULL while hearing_offered_label='Yes' for 3,803 OTC rows (derived from other signals) — see gotchas. |
| hearing_offered_label | varchar(3) | 'Yes'/'No' offered. Yes=387,680 / No=205,787 / NULL=39,494. Slightly more 'Yes' than the raw code has (3,803 derived) — prefer hearing_offered (boolean) as the clean flag. |
| hearing_otc_indicator | boolean | Boolean: row is an OTC hearing-aid benefit. True only ~14,990 rows (B18C, 2025+). NULL for all non-OTC rows. |
| hearing_otc_indicator_code | string | OTC code 1=Yes. NULL for non-OTC rows (~617,971). |
| hearing_otc_indicator_label | string | 'Yes' for OTC rows; NULL otherwise. |
| hearing_package_id | string |  |
| hearing_package_name | string |  |
| hearing_package_type_code | string |  |
| hearing_pooled_group_amount | double |  |
| hearing_pooled_group_category_codes | string |  |
| hearing_pooled_group_period_code | string |  |
| hearing_rx_otc_choice_code | string |  |
| hearing_rx_otc_choice_required | boolean |  |
| hearing_section_d_group_index | int |  |
| hearing_section_d_group_name | string |  |
| hearing_service_selected_in_18a | boolean |  |
| hearing_sub_benefit | string | THE finest benefit dimension and part of grain. 8 values: routine_hearing_exam, hearing_aid_fitting_evaluation (these two are a deterministic fan-out of B18A — identical counts 201,488 each), prescription_hearing_aids_all_types, prescription_hearing_aids_over/inner/outer_ear, otc_hearing_aids (2025+), replacement_batteries (2001 ONLY). |
| hearing_targeting | varchar(36) |  |
| source_amount_column | string | Provenance: the raw PBP column the amount came from, e.g. 'pbp_b18a_maxplan_amt'. Maps row to its source field. |
| source_period_column | string | Provenance: the raw PBP period column, e.g. 'pbp_b18a_maxplan_per'. |
| source_pbp_section | string | PBP section: B18A (exams, 402,976), B18B (Rx aids, 214,995), B18C (OTC aids, 14,990). Redundant with hearing_sub_benefit (derivable) — NOT needed in the grain. |
| source_silver_table | varchar(63) | DEGENERATE: constant 'medicare_silver.pbp_section_b18_hearing_exams_aids' — the single upstream silver table this view is built from. |
| lmi_authorities | string | EMPTY ('') for all 632,961 rows — the LMI (lawful-monetary-interpretation/authority) annotation is not populated for the hearing view. Do not rely on it here. |
| source_url | string | The CMS PBP PUF download URL the row came from (e.g. .../pbp-benefits-2001.zip). 40 distinct = 40 file releases, 1:1 with (report_year,quarter). |
| sha256_content_hash | string | Content hash of the source file. 40 distinct, 1:1 with source_url and (report_year,quarter) — identifies the exact CMS release/snapshot for provenance. |

Tools that read it: get_pbp_benefit

Query it: `query_substrate` with `SELECT ... FROM medicare_semantic.vw_pbp_hearing WHERE ... LIMIT 100`; read `describe_data_source("medicare_semantic.vw_pbp_hearing")` first.