MA pbp section b20

What it is

1. 1CMS Plan Benefit Package (PBP) Section B-20, the cost-sharing/benefit design for OUTPATIENT (Medicare Part B) DRUGS in Medicare Advantage / Part C plans.
2. 2One row encodes what an enrollee pays for Part B-covered outpatient drugs (chemotherapy/radiation, insulin, other Part B drugs) under a specific MA plan: whether prior authorization is required, the coinsurance % and/or copay, deductible, max out-of-pocket, plus supplemental Part C outpatient-drug and Part D home-infusion bundling.
3. 3Sourced from the quarterly CMS PBP PUF zips.
4. 4This slice is a small sample (7 contracts, 50 plans) for demo, not the full national MA universe.

Grain

How to read it

1. 1Get the latest-snapshot Part B outpatient-drug cost sharing for each plan in 2024: pick one row per plan from the most recent quarterly PUF, then read the coinsurance. e.g.
2. 2SELECT contract_id, plan_id, pbp_b20_coins_mc_yn, pbp_b20_coins_mc_pct, pbp_b20_auth_yn FROM pbp_section_b20 WHERE report_year=2024 AND quarter=(SELECT max(quarter) FROM pbp_section_b20 WHERE report_year=2024) — answers 'what do these MA plans charge enrollees (coinsurance %) for Medicare Part B drugs, and do they require prior authorization?' To trend across years, GROUP BY contract_id,plan_id,report_year and take the latest quarter per year to avoid double-counting the republished snapshots.

Traps

1. 1NO is_current / no dedup, and NO single-version flag. The 463 rows are only 215 distinct plan-years (contract×plan×segment×report_year) republished across 19 quarterly PUF snapshots. Summing or counting rows double-counts plans. To get one row per plan-year, filter to a chosen snapshot (e.g. the max cms_vintage_sequence / latest quarter per report_year) or GROUP to the (contract,plan,segment,report_year) grain.
2. 2'version' is a TRAP for picking 'latest'. It is the plan's bid Version Number (a per-contract attribute that differs across contracts within the very same snapshot, e.g. v1/v5/v8 all in 2020-Q4), NOT a global data vintage. Use cms_vintage_sequence + quarter for snapshot recency; use asserted_at for nothing data-related (it's just the load date).
3. 3bid_id, observed_period, and effective_period_start are all redundant restatements of the grain (bid_id = contract_plan_segment; observed_period/effective_period_start = Jan-1 of report_year). pbp_b20_bendesc_grp_num LOOKS like a sub-grain but is NOT — there is exactly one row per plan per snapshot.
4. 4This table is Medicare Part B / OUTPATIENT DRUGS (chemo, insulin, other Part B drugs administered in a clinical setting) under MA plans — it is NOT Part D pharmacy benefits. For Part D drug tiers/formulary use the pbp_mrx* tables; sibling pbp_section_b15_partb_rx_drugs also covers Part B Rx, so confirm which section the use-case needs. B20 ('Outpatient Drugs') carries the prior-auth, coinsurance (mostly the standard 20%), and supplemental-bundling design.
5. 5Most fields are NULL by design: deductible amount, copay amounts, MOOP, addl_cost, all grp1-5 supplemental blocks, and the maxplan_* caps are almost entirely empty — the sampled plans price Part B drugs via simple Medicare-covered coinsurance (commonly 20%). A NULL _yn means the question wasn't answered/parsed (10 all-null placeholder rows = plan_type '02'/orgtype '01'); a '2' explicitly means 'No'. coins_mc_ehc is a concatenated bitmask code string ('11','101'), not a numeric value.
6. 6This is a small SAMPLE (7 contracts / 50 plans), not the national MA universe. Do not treat counts here as population statistics.

Columns (299)

Query it

describe_data_source(source_fqn="medicare_silver.pbp_section_b20")     # the card, live
query_substrate(sql="SELECT * FROM medicare_silver.pbp_section_b20 WHERE contract_id = '<value>' AND plan_id = '<value>' AND segment_id = '<value>' AND report_year = '<value>' AND quarter = '<value>' LIMIT 100")