CMS Data Available To You

It's important to know how to access and use CMS Data to better serve your clients, strategically market, and know what resources are available to them. Listen in to ensure you stand out to your clients based on your knowledge of the industry and how you can help them.

 

Informational Sources:

Provider Payments: https://www.cms.gov/medicare/payment/fee-schedules

Broker Compensation: https://www.cms.gov/medicare/payment/fee-schedules

https://www.cms.gov/priorities/key-initiatives/healthplan-price-transparency

https://www.cms.gov/healthplan-price-transparency/plans-and-issuers

Cross walk:  https://www.cms.gov/research-statistics-data-and-systemsstatistics-trends-and-reportsmcradvpartdenroldataplan-crosswalks/2023-part-cd-plan-crosswalk

Landscapes:  https://www.cms.gov/medicare/coverage/prescription-drug-coverage

https://www.cms.gov/data-research/monitoring-programs/improper-payment-measurement-programs/payment-error-rate-measurement-perm/corrective-action-plan-cap-process#:~:text=A%20CAP%20is%20a%20narrative,improper%20payments%20in%20each%20program

https://www.cms.gov/data-research/statistics-trends-and-reports/medicare-advantagepart-d-contract-and-enrollment-data/corrective-action-plans

CAP Process: http://www.cms.gov/research-statistics-data-and-systems/monitoring-programs/perm/downloads/2013correctiveactionpowerpoint.pdf

 

Enrollment Data: See what is selling in your neck of the woods and ensure you are licensed with competitive plans. This can also indicate what carriers are in network with doctors and hospitals locally 

• By Plan: https://www.cms.gov/data-research/statistics-trends-and-reports/medicare-advantagepart-d-contract-and-enrollment-data/monthly-enrollment-plan  
• By State: https://www.cms.gov/data-research/statistics-trends-and-reports/medicare-advantagepart-d-contract-and-enrollment-data/monthly-enrollment-state  
• By County/plan/state: https://www.cms.gov/data-research/statistics-trends-and-reports/medicare-advantagepart-d-contract-and-enrollment-data/ma-state/county-penetration 
• Strategic Planning Tool – The Medicare Enrollment Dashboard: Monitor enrollment statistics issued by CMS while developing your business plan for AEP and beyond. https://www.cms.gov/data-research/statistics-trends-and-reports/medicare-advantagepart-d-contract-and-enrollment-data/monthly-ma-enrollment-state/county/contract 
• Dashboard: https://data.cms.gov/tools/medicare-enrollment-dashboard 

Star ratings 

• What Star Ratings Mean- what is it measuring: https://www.cms.gov/medicare/health-drug-plans/part-c-d-performance-data  
  • www.cms.gov/files/document/2023-medicare-star-ratings-fact-sheet.pdf 

 

Medicare Communications & Marketing Guidelines 

CMS Newsroom https://www.cms.gov/about-cms/contact/newsroom  

 

LIS Data - resources for LIS clients  

https://www.cms.gov/training-education/partner-outreach-resources/low-income-subsidy-lis 

Where can I learn more about the LIS? 

• LIS notices and mailings. 
• Consumer mailings (PDF) 
• Information partners can use on: Reassignment (PDF) 
• Medicare Limited Income NET Program 
• LIS Resource Limits Memo (PDF) 
• Fact Sheet – What to Do if You No Longer Automatically Qualify for Extra Help 
• Apply online for extra help and get additional information at Social Security Administration

Employer and Union Retiree Drug Subsidy:  

• https://www.cms.gov/medicare/coordination-benefits-recovery/employer-services/union-retiree-drug-subsidy 

 

Appeal forms – drugs https://www.cms.gov/medicare/appeals-grievances/prescription-drug/forms   https://www.cms.gov/medicare/appeals-grievances/prescription-drug/exceptions