[Data Formatted for Mapping] The Innovation Center develops new payment and service delivery models in accordance with the requirements of section 1115A of the Social Security Act. Additionally, Congress has defined – both through the Affordable Care Act and previous legislation – a number of specific demonstrations to be conducted by CMS.
Section 6401 (a) of the Affordable Care Act established a requirement for all enrolled providers/suppliers to revalidate their Medicare enrollment information under new enrollment screening criteria. CMS has completed its initial round of revalidations and will be resuming regular revalidation cycles in accordance with 42 CFR §424.515. In an effort to streamline the revalidation process and reduce provider/supplier burden, CMS has implemented several revalidation processing improvements one of which is established due dates by which you must revalidate.
The Comprehensive Primary Care (CPC) initiative is a multi-payer initiative fostering collaboration between public and private health care payers to strengthen primary care. Medicare will work with commercial and State health insurance plans and offer bonus payments to primary care doctors who better coordinate care for their patients. Primary care practices that choose to participate in this initiative will be given resources to better coordinate primary care for their Medicare patients.
All figures are based on plan selections with coverage periods that include March 2016. A consumer's household income as a percent of the Federal Poverty Level (FPL) is documented when a consumer provides his or her household income; income is not a required field and may be missing on an application. Once the household income data is provided, along with the number of household members, the income level as a percent of the Federal Poverty Level is calculated. Guidelines for calculating FPL are set on a yearly basis by the U.S. Census Bureau.
All figures are based on plan selections with coverage periods that include March 2016. Returning consumers had an active plan selection with 2015 coverage on or after 11/1/2015. Returning consumers were further classified into two sub-types: (i) those who were auto enrolled into the same or similar plan in 2016 and (ii) those who actively selected a new plan for coverage year 2016. Consumers were classified as new if they did not have an active plan selection in 2015 with coverage on or after 11/1/2015.
All figures are based on plan selections with coverage periods that include March 2016. The consumer's self-reported race/ethnicity when selecting a plan. This field is not mandatory. A hierarchy for determining the best race value was applied to the data. If a consumer with a populated ethnicity variable selected his or her ethnicity as “Cuban”, “Mexican, Mexican American, or Chicano/a" or "Puerto Rican", or “Other Ethnicity” then a consumer was classified as “Latino”. If a consumer was not Latino and selected more than one distinct race type, then he or she was classified as ”Multiracial”. If a consumer was not Latino and selected only one race type, it was reported. Otherwise, a consumer’s race/ethnicity was classified as "Unknown".
All figures are based on plan selections with coverage periods that include March 2016. A consumer's metal level corresponds to the policy that he or she selected. Metal levels include platinum, gold, silver, bronze, and catastrophic plans. Catastrophic plans have the lowest premiums, but the highest deductibles and other out-of-pocket expenses, while platinum have the highest premiums and lowest deductibles and out-of-pocket costs. All states allow the sale of gold, silver, and bronze plans but may not allow the sale of platinum and/or catastrophic plans. Additionally, catastrophic plans are generally only available to consumers younger than 30.
All figures are based on plan selections with coverage periods that include March 2016. A consumer's age was calculated as of the policy start date on the best 2016 policy; consumers were then then classified into the various age groups.
All figures are based on plan selections with coverage periods that include March 2016. Cost-Sharing Reduction (CSR) is generally available if a consumer’s household income is between 100 percent and 250 percent of the federal poverty level and the individual chooses a health plan from the silver plan category. For silver plans, the actuarial value of 70% refers to the average out-of-pocket costs covered by the issuer. Consumers receiving CSR have higher actuarial values (up to 94%) and are classified as receiving CSR; otherwise, a consumer was classified as not having CSR.
All figures are based on plan selections with coverage periods that include March 2016. Advanced Premium Tax Credit (APTC) is generally available if a consumer's household income is between 100 and 400 percent of the federal poverty level. A consumer was defined as having an APTC if his or her applied APTC amount was greater than $0; otherwise, a consumer was classified as not having APTC.