MA pbp section b6 home health

What it is

1. 1CMS Medicare Advantage Plan Benefit Package (PBP) Section B-6: the home-health cost-sharing and access rules each MA / MA-PD plan files with CMS.
2. 2One row states, for a given plan-year snapshot, whether home-health visits carry a copay/coinsurance/deductible (and the dollar/percent amounts), whether prior auth or referral is required, any benefit caps, and any added non-Medicare-covered in-home services.
3. 3It is the authoritative cost-sharing benchmark for Medicare Advantage home-health benefits.

Grain

How to read it

1. 1To benchmark Medicare Advantage home-health cost-sharing for the latest plan year, pin to one snapshot per plan and read the master flags + mc amounts.
2. 2Example: SELECT contract_id, plan_id, segment_id, pbp_a_plan_type, pbp_b6_auth_yn, pbp_b6_copay_yn, pbp_b6_copay_mc_amt_min, pbp_b6_copay_mc_amt_max, pbp_b6_coins_yn, pbp_b6_coins_pct_mc FROM medicare_silver.pbp_section_b6_home_health WHERE report_year = 2026 AND quarter = 1 — answers 'which MA plans require prior auth for home health, and what copay/coinsurance do they charge?' To trend over time, GROUP BY report_year using a single quarter per year (e.g. quarter = 1, or MAX(quarter)) to avoid quarterly double-counting.

Traps

1. 1NOT one-row-per-plan-per-year. quarter is part of the grain: 2001-2017 publish Q1 only, but 2018+ publish up to 4 quarterly snapshots of the SAME plan-year (e.g. 2023 has Q1-Q4). Naively counting rows or joining without pinning quarter double/quadruple-counts recent plan-years. For a per-plan-year view, filter to one quarter (e.g. MAX(quarter) per report_year) or to quarter=1.
2. 2There is NO is_current column and no within-grain dedup is needed — each (contract,plan,segment,report_year,quarter) has exactly one row / one cms_vintage_sequence (verified 0 multi-vintage groups). cms_vintage_sequence (1-4) and parse_revision are provenance/ingest-batch markers, NOT version flags to filter on; asserted_at (only 2026-05-16 / 2026-05-20) is the lake LOAD date, not a benefit date.
3. 3bid_id LOOKS like a primary key but is not: it is the derived concat contract_id_plan_id_segment_id and is NULL for 8,316 early-year rows, so DISTINCT bid_id (23,191) under-counts the real plan population (26,631 contract+plan+segment combos). Use the three ID columns, not bid_id.
4. 4_yn flags follow CMS convention '1'=Yes, '2'=No, and NULL = not collected in that year's PBP version (PBP schema changed over 25 years) — NULL does not mean 'No'. The flag gates its amount columns: copay/coins/deductible dollar+percent fields are only populated when the matching *_yn='1'. Deductible is essentially always '2'/No (Original-Medicare home health has no deductible; only 3 rows carry an amount).
5. 5Most measure columns are extremely sparse and benefit-specific. The entire pbp_b6_mm_* sub-block (additional / Non-Medicare-Covered in-home support services) is NULL in ~200,350 of 201,488 rows (mm_nmc_yn set in just 1,138). Many _pos (point-of-service/out-of-network) columns are vestigial (e.g. pbp_b6_copay_amtv_pos is 100% NULL). Suffixes encode home-health sub-categories: mc=Medicare-covered (the main one), hs/rc/cc=other sub-services; pull the mc and the *_yn columns for the core cost-sharing story.
6. 6Sibling-table caveat: this is ONLY PBP Section B-6 (home health). Other pbp_section_b* tables hold other benefit categories (B-1 inpatient, B-7 professional, etc.) at the SAME plan grain — do not assume a plan's home-health cost-share generalizes. report_year/observed_period/effective_period_start are all the same year (redundant); effective_period_end is always Dec 31 of that year.

Columns (165)

Query it

describe_data_source(source_fqn="medicare_silver.pbp_section_b6_home_health")     # the card, live
query_substrate(sql="SELECT * FROM medicare_silver.pbp_section_b6_home_health WHERE contract_id = '<value>' AND plan_id = '<value>' AND segment_id = '<value>' AND report_year = '<value>' AND quarter = '<value>' LIMIT 100")