MA pbp section b9 outpat hosp

What it is

1. 1CMS Plan Benefit Package (PBP) Section B9 — the member cost-sharing (copays, coinsurance, deductibles, out-of-pocket maximums, and prior-authorization/referral rules) that Medicare Advantage plans set for OUTPATIENT HOSPITAL services, filed annually (and refreshed quarterly) with CMS.
2. 2It is benefit-design / member-liability data for MA plans, not a provider payment-rate benchmark.

Grain

How to read it

1. 1Look up a Medicare Advantage plan's outpatient-hospital member cost-sharing for a given year, using the latest snapshot of that year.
2. 2Example: SELECT contract_id, plan_id, segment_id, pbp_b9a_copay_ohs_amt_min, pbp_b9a_copay_ohs_amt_max, pbp_b9a_coins_pct_mc FROM medicare_silver.pbp_section_b9_outpat_hosp WHERE report_year=2026 AND quarter=1 AND contract_id='H0028' AND plan_id='004' — answers 'what does this MA plan charge members (copay range / coinsurance %) for outpatient hospital services in 2026?'.
3. 3To compare across all plans, add the quarter filter to avoid double-counting the same plan-year's multiple quarterly releases.

Traps

1. 1GRAIN TRAP: the profiler reports a 12-column 'verified unique' superset that includes pbp_b9_maxplan_yesno_pos, pbp_b9b/c/d_maxplan_yesno_pos. Those four columns (and many *_pos / *_yesno / base pbp_b9_* columns) are 100% NULL, so they add zero distinctness. The TRUE minimal grain is just contract_id × plan_id × segment_id × report_year × quarter = 196,319 distinct = the full row count. (effective_period_start can substitute for report_year, and bid_id for contract||plan||segment, but neither adds a dimension.)
2. 2NO is_current / no dedup flag. The table is an append of EVERY CMS quarterly PBP release across 21 plan years. The same plan-year appears in up to 4 quarterly snapshots and the benefit VALUES can differ between them (carriers re-file: version increments, copays change). To get 'the' benefits for a plan year you MUST pick one snapshot — filter to a single (report_year, quarter), normally the latest quarter present for that year (check the ry/quarter inventory: e.g. 2021/2024 have no Q2, 2020 has no Q3, 2025/2026 are Q1-only).
3. 3quarter is a SNAPSHOT/vintage axis, not an effective-date axis. All quarters of a report_year share effective_period 2026-01-01..12-31 (etc.). Do not read quarter as 'benefits effective in Q2'; read it as 'the Q2 re-release of that plan year's filing'. cms_vintage_sequence is a messy proxy for it and is NOT 1:1 with quarter — trust (report_year, quarter).
4. 4Mostly-NULL columns carry meaning, three ways: (1) ~9,400 rows have ALL B9 sub-section yn NULL = the plan did not file B9 cost-sharing that snapshot (342 of those have pbp_a_ben_cov NULL = no benefit record at all). (2) Within a filed row, a NULL copay/coins amount means that cost-share type doesn't apply (read the matching _yn = '2'/No first). (3) _yn codes are CMS 1=Yes / 2=No (NOT 0/1) — a NULL _yn is 'not applicable', distinct from '2'=explicitly No.
5. 5Sub-sections a/b/c/d are NOT independent benefits you pick one of — virtually every plan files all four (B9a outpatient-hospital with obs/ohs split, B9b flat-copay tier, B9c tiered group/individual sessions via mcgs/mcis intervals, B9d plan-described benefit). Within B9a, _obs (Observation Services) and _ohs (Outpatient Hospital Services) are SEPARATE cost-shares (different copays) — don't collapse them. This is plan COST-SHARING (what the member pays), not a provider payment/price benchmark; for actual Medicare facility prices use medicare_silver.medicare_opps_rates.
6. 6version is the CMS bid version (0-27), not a vintage/dedup key — never use it to dedup. Likewise asserted_at is Vlada's load date (2026-05-16/20 here), not the CMS publish date; cms_vintage_sequence/parse_revision/parser_artifact_hash/sha256_content_hash/source_url are all ingestion provenance, not benefit content.

Columns (236)

Query it

describe_data_source(source_fqn="medicare_silver.pbp_section_b9_outpat_hosp")     # the card, live
query_substrate(sql="SELECT * FROM medicare_silver.pbp_section_b9_outpat_hosp WHERE contract_id = '<value>' AND plan_id = '<value>' AND segment_id = '<value>' AND report_year = '<value>' AND quarter = '<value>' LIMIT 100")