Tip: Medicare Advantage Plans

Number	0048
Submitting Entities	ALL
Add Date	Mar 11, 2020
Update Date	Jul 14, 2022 May 25, 2023 Mar 13, 2024
Update	Updated instructions to identify Medicare Advantage Plans. Included in March 2024 data tip email.
Description	Identifying Medicare Advantage Plans
Action / Resolution	Medicare Advantage plans do not always have plan names that can easily be identified as Medicare Advantage. These plans can be identified when Insurance Product Type Code (ME003, MC003, PC003) contains the values (MDV','HN','HS','MCR','MA','MB','MH', ‘MHO','MI','MPO' or ME001, MC001, or PC001 in ('10155',’60054M') Alternately, if the data requester has access to Medicare Fee for Service data (available to state agencies only), Medicare Advantage plans are identified in the following way: [HMO_IND_01] = '0' beneficiary enrolled in Fee for service plan in January of the enrollment year [HMO_IND_02] = '0' beneficiary enrolled in Fee for service plan in February of the enrollment year [HMO_IND_03] = '0' beneficiary enrolled in Fee for service plan in March of the enrollment year [HMO_IND_04] = '0' beneficiary enrolled in Fee for service plan in April of the enrollment year [HMO_IND_05] = '0' beneficiary enrolled in Fee for service plan in May of the enrollment year [HMO_IND_06] = '0' beneficiary enrolled in Fee for service plan in June of the enrollment year [HMO_IND_07] = '0' beneficiary enrolled in Fee for service plan in July of the enrollment year [HMO_IND_08] = '0' beneficiary enrolled in Fee for service plan in August of the enrollment year [HMO_IND_09] = '0' beneficiary enrolled in Fee for service plan in September of the enrollment year [HMO_IND_10] = '0' beneficiary enrolled in Fee for service plan in October of the enrollment year [HMO_IND_11] = '0' beneficiary enrolled in Fee for service plan in November of the enrollment year [HMO_IND_12] = '0' beneficiary enrolled in Fee for service plan in December of the enrollment year [HMO_IND_01] = 'C' beneficiary enrolled in Medicare Advantage plan in January of the enrollment year [HMO_IND_02] = 'C' beneficiary enrolled in Medicare Advantage plan in February of the enrollment year [HMO_IND_03] = 'C' beneficiary enrolled in Medicare Advantage plan in March of the enrollment year [HMO_IND_04] = 'C' beneficiary enrolled in Medicare Advantage plan in April of the enrollment year [HMO_IND_05] = 'C' beneficiary enrolled in Medicare Advantage plan in May of the enrollment year [HMO_IND_06] = 'C' beneficiary enrolled in Medicare Advantage plan in June of the enrollment year [HMO_IND_07] = 'C' beneficiary enrolled in Medicare Advantage plan in July of the enrollment year [HMO_IND_08] = 'C' beneficiary enrolled in Medicare Advantage plan in August of the enrollment year [HMO_IND_09] = 'C' beneficiary enrolled in Medicare Advantage plan in September of the enrollment year [HMO_IND_10] = 'C' beneficiary enrolled in Medicare Advantage plan in October of the enrollment year [HMO_IND_11] = 'C' beneficiary enrolled in Medicare Advantage plan in November of the enrollment year [HMO_IND_12] = 'C' beneficiary enrolled in Medicare Advantage plan in December of the enrollment year
Category 1	Medicare Advantage
Category 2	Medicare
Tip / Issue	Tip