haau3 FHIR Implementation Guide (HFIG)
1.0.0 - ci-build United States of America flag

haau3 FHIR Implementation Guide (HFIG) - Local Development build (v1.0.0) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions

Extension: Plan Benefits Medicare-Defined Amount

Official URL: https://haau3.com/fhir/StructureDefinition/plan-benefits-medicare-defined Version: 1.0.0
Draft as of 2026-10-14 Computable Name: PlanBenefitsMedicareDefined

A Medicare Advantage plan files this amount as Original Medicare's own, with no number of its own: a deductible, or hospital or skilled nursing cost sharing. The part says which. Where haau3 holds Original Medicare's published amounts, they come with the year they belong to and their source. If that year is not the plan's year (CMS publishes each year's amounts in mid-November of the year before), the cost's value carries a data-absent reason and the amounts here are the latest published, which may change. The SBC profile has no way to say an amount is Medicare's; haau3 publishes this extension until the SBC guide does.

Context of Use

Usage info

Usages:

You can also check for usages in the FHIR IG Statistics

Formal Views of Extension Content

Description of Profiles, Differentials, Snapshots, and how the XML and JSON presentations work.

This structure is derived from Extension

NameFlagsCard.TypeDescription & Constraints    Filter: doco
Extension C 0..* Extension Plan Benefits Medicare-Defined Amount
Constraints: plan-benefits-3
Extension.extension 1..* Extension Extension
Extension.Slices for extension Content/Rules for all slices
Extension.Slices for extension.extension:part 1..1 Extension Which part of Original Medicare the amount is
Extension.Slices for extension.extension:part.extension 0..0 Extension
Extension.Slices for extension.extension:part.url 1..1 uri "part"
Extension.Slices for extension.extension:part.value[x] 0..1 code Value of extension
Binding: Plan Benefits Medicare Part (required)
Extension.Slices for extension.extension:year 0..1 Extension The year the amounts here belong to
Extension.Slices for extension.extension:year.extension 0..0 Extension
Extension.Slices for extension.extension:year.url 1..1 uri "year"
Extension.Slices for extension.extension:year.value[x] 0..1 date Value of extension
Extension.Slices for extension.extension:source 0..1 Extension Where Original Medicare's amounts were published
Extension.Slices for extension.extension:source.extension 0..0 Extension
Extension.Slices for extension.extension:source.url 1..1 uri "source"
Extension.Slices for extension.extension:source.value[x] 0..1 uri Value of extension
Extension.Slices for extension.extension:amount 0..* Extension One of Original Medicare's published amounts
Extension.Slices for extension.extension:amount.extension 2..* Extension Extension
Extension.Slices for extension.extension:amount.Slices for extension Content/Rules for all slices
Extension.Slices for extension.extension:amount.Slices for extension.extension:kind 1..1 Extension Which of Original Medicare's amounts this is
Extension.Slices for extension.extension:amount.Slices for extension.extension:kind.extension 0..0 Extension
Extension.Slices for extension.extension:amount.Slices for extension.extension:kind.url 1..1 uri "kind"
Extension.Slices for extension.extension:amount.Slices for extension.extension:kind.value[x] 0..1 code Value of extension
Binding: Plan Benefits Medicare Amount (required)
Extension.Slices for extension.extension:amount.Slices for extension.extension:value 1..1 Extension The amount
Extension.Slices for extension.extension:amount.Slices for extension.extension:value.extension 0..0 Extension
Extension.Slices for extension.extension:amount.Slices for extension.extension:value.url 1..1 uri "value"
Extension.Slices for extension.extension:amount.Slices for extension.extension:value.value[x] 0..1 Money Value of extension
Extension.Slices for extension.extension:amount.url 1..1 uri "amount"
Extension.Slices for extension.extension:amount.value[x] 0..0 Value of extension
Extension.url 1..1 uri "https://haau3.com/fhir/StructureDefinition/plan-benefits-medicare-defined"

doco Documentation for this format
NameFlagsCard.TypeDescription & Constraints    Filter: doco
Extension C 0..* Extension Plan Benefits Medicare-Defined Amount
Constraints: plan-benefits-3
Extension.id 0..1 string Unique id for inter-element referencing
Extension.Slices for extension 1..* Extension Extension
Slice: Unordered, Open by value:url

Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
Extension.Slices for extension.extension:part 1..1 Extension Which part of Original Medicare the amount is
Extension.Slices for extension.extension:part.id 0..1 string Unique id for inter-element referencing
Extension.Slices for extension.extension:part.extension 0..0 Extension
Slice: Unordered, Open by value:url

Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
Extension.Slices for extension.extension:part.url 1..1 uri "part"
Extension.Slices for extension.extension:part.value[x] 0..1 code Value of extension
Binding: Plan Benefits Medicare Part (required)
Extension.Slices for extension.extension:year 0..1 Extension The year the amounts here belong to
Extension.Slices for extension.extension:year.id 0..1 string Unique id for inter-element referencing
Extension.Slices for extension.extension:year.extension 0..0 Extension
Slice: Unordered, Open by value:url

Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
Extension.Slices for extension.extension:year.url 1..1 uri "year"
Extension.Slices for extension.extension:year.value[x] 0..1 date Value of extension
Extension.Slices for extension.extension:source 0..1 Extension Where Original Medicare's amounts were published
Extension.Slices for extension.extension:source.id 0..1 string Unique id for inter-element referencing
Extension.Slices for extension.extension:source.extension 0..0 Extension
Slice: Unordered, Open by value:url

Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
Extension.Slices for extension.extension:source.url 1..1 uri "source"
Extension.Slices for extension.extension:source.value[x] 0..1 uri Value of extension
Extension.Slices for extension.extension:amount 0..* Extension One of Original Medicare's published amounts
Extension.Slices for extension.extension:amount.id 0..1 string Unique id for inter-element referencing
Extension.Slices for extension.extension:amount.Slices for extension 2..* Extension Extension
Slice: Unordered, Open by value:url

Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
Extension.Slices for extension.extension:amount.Slices for extension Content/Rules for all slices
Extension.Slices for extension.extension:amount.Slices for extension.extension:kind 1..1 Extension Which of Original Medicare's amounts this is
Extension.Slices for extension.extension:amount.Slices for extension.extension:kind.id 0..1 string Unique id for inter-element referencing
Extension.Slices for extension.extension:amount.Slices for extension.extension:kind.extension 0..0 Extension
Slice: Unordered, Open by value:url

Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
Extension.Slices for extension.extension:amount.Slices for extension.extension:kind.url 1..1 uri "kind"
Extension.Slices for extension.extension:amount.Slices for extension.extension:kind.value[x] 0..1 code Value of extension
Binding: Plan Benefits Medicare Amount (required)
Extension.Slices for extension.extension:amount.Slices for extension.extension:value 1..1 Extension The amount
Extension.Slices for extension.extension:amount.Slices for extension.extension:value.id 0..1 string Unique id for inter-element referencing
Extension.Slices for extension.extension:amount.Slices for extension.extension:value.extension 0..0 Extension
Slice: Unordered, Open by value:url

Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
Extension.Slices for extension.extension:amount.Slices for extension.extension:value.url 1..1 uri "value"
Extension.Slices for extension.extension:amount.Slices for extension.extension:value.value[x] 0..1 Money Value of extension
Extension.Slices for extension.extension:amount.url 1..1 uri "amount"
Extension.url 1..1 uri "https://haau3.com/fhir/StructureDefinition/plan-benefits-medicare-defined"

doco Documentation for this format

This structure is derived from Extension

Summary

Complex Extension: A Medicare Advantage plan files this amount as Original Medicare's own, with no number of its own: a deductible, or hospital or skilled nursing cost sharing. The part says which. Where haau3 holds Original Medicare's published amounts, they come with the year they belong to and their source. If that year is not the plan's year (CMS publishes each year's amounts in mid-November of the year before), the cost's value carries a data-absent reason and the amounts here are the latest published, which may change. The SBC profile has no way to say an amount is Medicare's; haau3 publishes this extension until the SBC guide does.

  • part: code: An Extension
  • year: date: An Extension
  • source: uri: An Extension
  • kind: code: An Extension
  • value: Money: An Extension

Differential View

This structure is derived from Extension

NameFlagsCard.TypeDescription & Constraints    Filter: doco
Extension C 0..* Extension Plan Benefits Medicare-Defined Amount
Constraints: plan-benefits-3
Extension.extension 1..* Extension Extension
Extension.Slices for extension Content/Rules for all slices
Extension.Slices for extension.extension:part 1..1 Extension Which part of Original Medicare the amount is
Extension.Slices for extension.extension:part.extension 0..0 Extension
Extension.Slices for extension.extension:part.url 1..1 uri "part"
Extension.Slices for extension.extension:part.value[x] 0..1 code Value of extension
Binding: Plan Benefits Medicare Part (required)
Extension.Slices for extension.extension:year 0..1 Extension The year the amounts here belong to
Extension.Slices for extension.extension:year.extension 0..0 Extension
Extension.Slices for extension.extension:year.url 1..1 uri "year"
Extension.Slices for extension.extension:year.value[x] 0..1 date Value of extension
Extension.Slices for extension.extension:source 0..1 Extension Where Original Medicare's amounts were published
Extension.Slices for extension.extension:source.extension 0..0 Extension
Extension.Slices for extension.extension:source.url 1..1 uri "source"
Extension.Slices for extension.extension:source.value[x] 0..1 uri Value of extension
Extension.Slices for extension.extension:amount 0..* Extension One of Original Medicare's published amounts
Extension.Slices for extension.extension:amount.extension 2..* Extension Extension
Extension.Slices for extension.extension:amount.Slices for extension Content/Rules for all slices
Extension.Slices for extension.extension:amount.Slices for extension.extension:kind 1..1 Extension Which of Original Medicare's amounts this is
Extension.Slices for extension.extension:amount.Slices for extension.extension:kind.extension 0..0 Extension
Extension.Slices for extension.extension:amount.Slices for extension.extension:kind.url 1..1 uri "kind"
Extension.Slices for extension.extension:amount.Slices for extension.extension:kind.value[x] 0..1 code Value of extension
Binding: Plan Benefits Medicare Amount (required)
Extension.Slices for extension.extension:amount.Slices for extension.extension:value 1..1 Extension The amount
Extension.Slices for extension.extension:amount.Slices for extension.extension:value.extension 0..0 Extension
Extension.Slices for extension.extension:amount.Slices for extension.extension:value.url 1..1 uri "value"
Extension.Slices for extension.extension:amount.Slices for extension.extension:value.value[x] 0..1 Money Value of extension
Extension.Slices for extension.extension:amount.url 1..1 uri "amount"
Extension.Slices for extension.extension:amount.value[x] 0..0 Value of extension
Extension.url 1..1 uri "https://haau3.com/fhir/StructureDefinition/plan-benefits-medicare-defined"
Extension.value[x] 0..0 Value of extension

doco Documentation for this format

Snapshot View

NameFlagsCard.TypeDescription & Constraints    Filter: doco
Extension C 0..* Extension Plan Benefits Medicare-Defined Amount
Constraints: plan-benefits-3
Extension.id 0..1 string Unique id for inter-element referencing
Extension.Slices for extension 1..* Extension Extension
Slice: Unordered, Open by value:url

Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
Extension.Slices for extension.extension:part 1..1 Extension Which part of Original Medicare the amount is
Extension.Slices for extension.extension:part.id 0..1 string Unique id for inter-element referencing
Extension.Slices for extension.extension:part.extension 0..0 Extension
Slice: Unordered, Open by value:url

Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
Extension.Slices for extension.extension:part.url 1..1 uri "part"
Extension.Slices for extension.extension:part.value[x] 0..1 code Value of extension
Binding: Plan Benefits Medicare Part (required)
Extension.Slices for extension.extension:year 0..1 Extension The year the amounts here belong to
Extension.Slices for extension.extension:year.id 0..1 string Unique id for inter-element referencing
Extension.Slices for extension.extension:year.extension 0..0 Extension
Slice: Unordered, Open by value:url

Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
Extension.Slices for extension.extension:year.url 1..1 uri "year"
Extension.Slices for extension.extension:year.value[x] 0..1 date Value of extension
Extension.Slices for extension.extension:source 0..1 Extension Where Original Medicare's amounts were published
Extension.Slices for extension.extension:source.id 0..1 string Unique id for inter-element referencing
Extension.Slices for extension.extension:source.extension 0..0 Extension
Slice: Unordered, Open by value:url

Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
Extension.Slices for extension.extension:source.url 1..1 uri "source"
Extension.Slices for extension.extension:source.value[x] 0..1 uri Value of extension
Extension.Slices for extension.extension:amount 0..* Extension One of Original Medicare's published amounts
Extension.Slices for extension.extension:amount.id 0..1 string Unique id for inter-element referencing
Extension.Slices for extension.extension:amount.Slices for extension 2..* Extension Extension
Slice: Unordered, Open by value:url

Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
Extension.Slices for extension.extension:amount.Slices for extension Content/Rules for all slices
Extension.Slices for extension.extension:amount.Slices for extension.extension:kind 1..1 Extension Which of Original Medicare's amounts this is
Extension.Slices for extension.extension:amount.Slices for extension.extension:kind.id 0..1 string Unique id for inter-element referencing
Extension.Slices for extension.extension:amount.Slices for extension.extension:kind.extension 0..0 Extension
Slice: Unordered, Open by value:url

Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
Extension.Slices for extension.extension:amount.Slices for extension.extension:kind.url 1..1 uri "kind"
Extension.Slices for extension.extension:amount.Slices for extension.extension:kind.value[x] 0..1 code Value of extension
Binding: Plan Benefits Medicare Amount (required)
Extension.Slices for extension.extension:amount.Slices for extension.extension:value 1..1 Extension The amount
Extension.Slices for extension.extension:amount.Slices for extension.extension:value.id 0..1 string Unique id for inter-element referencing
Extension.Slices for extension.extension:amount.Slices for extension.extension:value.extension 0..0 Extension
Slice: Unordered, Open by value:url

Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
Extension.Slices for extension.extension:amount.Slices for extension.extension:value.url 1..1 uri "value"
Extension.Slices for extension.extension:amount.Slices for extension.extension:value.value[x] 0..1 Money Value of extension
Extension.Slices for extension.extension:amount.url 1..1 uri "amount"
Extension.url 1..1 uri "https://haau3.com/fhir/StructureDefinition/plan-benefits-medicare-defined"

doco Documentation for this format

This structure is derived from Extension

Summary

Complex Extension: A Medicare Advantage plan files this amount as Original Medicare's own, with no number of its own: a deductible, or hospital or skilled nursing cost sharing. The part says which. Where haau3 holds Original Medicare's published amounts, they come with the year they belong to and their source. If that year is not the plan's year (CMS publishes each year's amounts in mid-November of the year before), the cost's value carries a data-absent reason and the amounts here are the latest published, which may change. The SBC profile has no way to say an amount is Medicare's; haau3 publishes this extension until the SBC guide does.

  • part: code: An Extension
  • year: date: An Extension
  • source: uri: An Extension
  • kind: code: An Extension
  • value: Money: An Extension

 

Other representations of profile: CSV, Excel, Schematron

Terminology Bindings

Path Status Usage ValueSet Version Source
Extension.extension:part.​value[x] Base required Plan Benefits Medicare Part 📦1.0.0 This IG
Extension.extension:amount.​extension:kind.value[x] Base required Plan Benefits Medicare Amount 📦1.0.0 This IG

Constraints

Id Grade Path(s) Description Expression
ele-1 error **ALL** elements All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ext-1 error **ALL** extensions Must have either extensions or value[x], not both extension.exists() != value.exists()
plan-benefits-3 error Extension An Original Medicare amount comes with the year it belongs to and its source. extension('amount').exists() implies (extension('year').exists() and extension('source').exists())