Coverage API

[Sabir Ali]

Hello Team,

Does Coverage API returns future cover plans as well which has not started yet, but patient have taken them?

Thanks

Sabir 

[Developer Group for CMS Blue Button API]

Hi Sabir, 

Are you asking if we return data for coverage dates that are in the future (e.g., coverage has not yet started)? We don't believe this is the case, but will get back to you with a confirmed answer. 

The Blue Button 2.0 Team

[Kirsten Hansen]

Hi Sabir,

After some researching, the Blue Button 2.0 API does supply coverage resources with start dates in the near future.  Usually, it is related to the initial enrollment period as described here: https://www.medicare.gov/basics/get-started-with-medicare/sign-up/when-does-medicare-coverage-start

Hope this helps,

Kirsten Hansen

Product Manager

Blue Button 2.0 API Team

[Rye Akervik]

Hi Kirsten, when you say near future how far is this in the future? I am assuming this would show things like plan changes which will go into effect in the near future? 

If you can let us know the range of 'near future' that would be great!

[Matt Thorpe]

Hi Kristen, 

Any update here on Rye's inquiry?

Thanks,

- Matt

[Kirsten Hansen]

Hi Matt & Rye,

A loose definition of 'near future' is showing future coverage dates less than one year out as this is based on initial enrollment scenarios (for example, a person can sign up for Medicare within 3 months of turning 65).  Medicare enrollees get accreted to the Medicare eligibility tables based on birthdate and prior to enrollment.  Note that in the analysis of the data, Medicare enrollees with future coverage dates accounts for less than 1% of all enrollees, so this is a very small number.
When you ask about "plan changes", can you provide specific examples of what you are looking for?



Thanks for reaching out,

Kirsten Hansen
Product Manager
Blue Button 2.0 API Team

[Rye Akervik]

[Rye Akervik]

Hi Kirsten,

I posted a query twice now but just realized the system is deleting it from our exchange. I think maybe because I was posting a link to a screenshot? Trying again without the screenshot link.

If a beneficiary signs up for a new MAPD while they're currently on a MAPD, the new MAPD shows up in their "My Plans" info. See above screenshot. Will that new MAPD data be included through the API when fetching their current plan?

Thanks!


Rye

[Kirsten Hansen]

Rye,We verified that only current plan information will be delivered. Any information about the new plan will not arrive until the new plan goes into effect.

Sincerely,

Kirsten Hansen

Product Manager,

Blue Button 2.0 API Team

[Evan MacGuffie]

Hey Kirsten,

I had the same question too.

See attached photo.

Is there a way to get the data from "Your Next Plan" through the API?

[Kirsten Hansen]

Hi Evan,

Thanks for your question. Even though this information may show up on the Medicare.gov account dashboard, it would not be available via the Blue Button 2.0 API. Some context to help you understand why is that our source system for claims data is the Chronic Conditions Warehouse (CCW). This is a research database which houses claims data, and was originally built for research purposes.The teams that support the Medicare.gov accounts and pages use various other systems as their source systems. They are able to pull data that we don’t currently have access to via the CCW. For this reason, you may see slight differences between what is on a Medicare.gov account and what comes through the API. Blue Button 2.0 was not designed to hold extensive enrollment data, but rather adjudicated claims. Though we do provide data in the /coverage endpoint, Medicare.gov most likely has more recent data around coverage and enrollment as that is a key workflow they support. At this time, we do not have plans to add in additional data sources to support historical enrollment data or information about plan changes.

Sincerely,

Kirsten Hansen

Product Manager

The Blue Button 2.0 API Team

[Evan MacGuffie]

Got it. One last question:

Is there an endpoint for the beneficiary's plan disenrollment date?

In the middle of the month, if a beneficiary signs up for a new MAPD or PDP, they'll be disenrolled from their current plan at the end of the current month. In some CMS systems, the "disenrollment date" is shown within 48 hours of CMS approving the new MAPD/PDP. 

For example I check today and see a disenrollment date of 4/30/2023. Is there a API endpoint that gives this info?

Thanks

[Tomomi Yamano]

I do not think so. Only the beneficiary's  enrollment data is mapped in the document. 

https://bluebutton.cms.gov/developers/#calling-the-api

--
You received this message because you are subscribed to the Google Groups "Developer Group for CMS Blue Button API" group.
To unsubscribe from this group and stop receiving emails from it, send an email to developer-group-for-cms-b...@googlegroups.com.
To view this discussion on the web visit https://groups.google.com/d/msgid/developer-group-for-cms-blue-button-api/e483953a-4841-49de-a70b-a1509f040d67n%40googlegroups.com.