Medicare Advantage Communications, Marketing and Training Rules
Medicare-Medicaid Plan (MMP) Marketing Information & Resources
This is a technical page, that will cross most anyone’s eyes.
- Medicare Communications & Marketing Guidelines:
- Marketing Website: cms.gov
- PFFS Addendum: Model Language for Sales Presentation cms.gov
General Information
Model Material Updates
- Quality Improvement Organization (QIO) Updates (PDF)
- CY 2021 MMP & MSHO Member Material Updates Memo (PDF)
Model Materials
- MMP & MSHO Plan Errata (04/15/2019) (DOCX)
- CY 2020 Explanation of Benefits – Drug-Only (DOCX)
- CY 2020 Explanation of Benefits – Integrated (DOCX)
State-Specific Information
California
- CY 2020 California MMP Model Materials Memo (PDF)
- CY 2020 California MMP Marketing Guidance Memo (PDF)
- CY 2020 California MMP Marketing Guidance (PDF)
- Member ID Card (2020) (ZIP)
- Member Handbook English (2020) (ZIP)
- Member Handbook Spanish (2020) (ZIP)
- Provider & Pharmacy Directory – English & Spanish (2020) (ZIP)
- Summary of Benefits – English & Spanish (2020) (ZIP)
- List of Covered Drugs – English & Spanish (2020) (ZIP)
- Delegated Notices (2020) (ZIP)
- Integrated Denial Notices (2020) (ZIP)
- Annual Notice of Change – English & Spanish (2020) (ZIP)
CMS imposes record number of fines 1st quarter 2015 Modern Health Care
Public Events Secret Shopping Tool CY 2014
Technical & Research Links
Medicare Modernization Act Wikipedia
Guidance for Eligibility, Enrollment and Disenrollment procedures for Medicare Advantage (MA) plans, including MA-PD plans, is provided in Chapter 2 of the Medicare Managed Care Manual.
Congressional Budget Office on how Medicare Advantage Plans Work
Medicare Marketing Website
Medicare Marketing Guidelines
FAQ’s
The Medicare Improvements for Patients and Providers Act (MIPPA)
Summary Public Law No: 110-275 Text – 105 Pages
42 CFR Part 422, Subpart V – Medicare Advantage Marketing Requirements
- § 422.2260 — Definitions concerning marketing materials.
- § 422.2262 — Review and distribution of marketing materials.
- § 422.2264 — Guidelines for CMS review.
- § 422.2266 — Deemed approval.
- § 422.2268 — Standards for MA organization marketing.
- § 422.2272 — Licensing of marketing representatives and confirmation of marketing resources.
- § 422.2274 — Broker and agent requirements.
- § 422.2276 — Employer group retiree marketing.
Part C—MEDICARE+CHOICE PROGRAM
Legal Codes
Plain English on Part C – Medicare Advantage
Sec. 1851. Eligibility, election, and enrollment
Sec. 1852. Benefits and beneficiary protections
Sec. 1853. Payments to Medicare+Choice organizations
Sec. 1854. Premiums and Premium Amounts
Sec. 1856. Establishment of standards
Sec. 1857. Contracts with Medicare+Choice organizations
Sec. 1858. Special Rules for MA Regional Plans
Sec. 1859. Definitions; miscellaneous provisions
42 CFR Part 422 – MEDICARE ADVANTAGE PROGRAM
- SUBPART A — General Provisions (§§ 422.1 – 422.6)
- SUBPART B — Eligibility, Election, and Enrollment (§§ 422.50 – 422.74)
- SUBPART C — Benefits and Beneficiary Protections (§§ 422.100 – 422.133)
- SUBPART D — Quality Improvement (§§ 422.152 – 422.158)
- SUBPART E — Relationships With Providers (§§ 422.200 – 422.220)
- SUBPART F — -Submission of Bids, Premiums, and Related Information and Plan Approval (§§ 422.250 – 422.270)
- SUBPART G — Payments to Medicare Advantage Organizations (§§ 422.300 – 422.324)
- SUBPART H — Provider-Sponsored Organizations (§§ 422.350 – 422.390)
- SUBPART I — Organization Compliance With State Law and Preemption by Federal Law (§§ 422.400 – 422.404)
- SUBPART J — Special Rules for MA Regional Plans (§§ 422.451 – 422.458)
- SUBPART K — –Application Procedures and Contracts for Medicare Advantage Organizations (§§ 422.500 – 422.527)
- SUBPART L — Effect of Change of Ownership or Leasing of Facilities During Term of Contract (§§ 422.550 – 422.553)
- SUBPART M — Grievances, Organization Determinations and Appeals (§§ 422.560 – 422.626)
- SUBPART N — Medicare Contract Determinations and Appeals (§§ 422.641 – 422.696)
- SUBPART O — Intermediate Sanctions (§§ 422.750 – 422.764)
- SUBPART P — S [Reserved]
- SUBPART T — Appeal procedures for Civil Money Penalties (§§ 422.1000 – 422.1094)
- SUBPART V — Medicare Advantage Marketing Requirements (§§ 422.2260 – 422.2276)
General information for organizations currently offering Medicare Advantage plans, or those planning to do so in the future ◦
http://www.cms.gov/HealthPlansGenInfo/
•Applications for organizations seeking to offer a Medicare Advantage plan ◦
http://www.cms.gov/MedicareAdvantageApps/
- Chapter 1 – General Provisions [PDF, 76KB]
- Chapter 3 – Marketing Guides Instructions [PDF, 47KB]
- Chapter 4 – Benefits and Beneficiary Protections [PDF, 522KB]
- Chapter 5 – Quality Assessment [PDF, 387KB]
- Chapter 6 – Relationships With Providers [PDF, 146KB]
- Chapter 7 – Risk Adjustment [PDF, 1MB]
- Chapter 8 – Payments to Medicare Advantage Organizations [PDF, 194KB]
- Chapter 9 – Employer/Union Sponsored Group Health Plans [PDF, 208KB]
- Chapter 10 – MA Organization Compliance with State Law and Preemption by Federal Law [PDF, 44KB]
- Chapter 11 – Medicare Advantage Application Procedures and Contract Requirements [PDF, 294KB]
- Chapter 12 – Effect of Change of Ownership [PDF, 70KB]
- Chapter 13 – Medicare Managed Care Beneficiary Grievances, Organization Determinations, and Appeals Applicable to Medicare Advantage Plans, Cost Plans, and Health Care Prepayment Plans (HCPPs), (collectively referred to as Medicare Health Plans) [PDF, 426KB]
- Chapter 14 – Contract Determinations and Appeals [PDF, 54KB]
- Chapter 15 – Intermediate Sanctions [PDF, 45KB]
- Chapter 16a – Subchapter A – Private Fee-for-Service (PFFS) Plans [PDF, 198KB]
- Chapter 16b – Subchapter B – Special Needs Plans [PDF, 273KB]
- Chapter 17a – Subchapter A – TEFRA Cost Based Payment Processes and Principles [PDF, 132KB]
- Chapter 17b – Subchapter B – Payment Principles for Cost-Based HMOs and CMPs [PDF, 283KB]
- Chapter 17c – Subchapter C – Cost Apportionment for Cost-Based HMOs and CMPs [PDF, 60KB]
- Chapter 17d – Subchapter D – Medicare Cost Plan Enrollment and Disenrollment Instructions [PDF, 381KB]
- Chapter 17f – Subchapter F – Benefits and Beneficiary Protections [PDF, 227KB]
- Chapter 18a – Subchapter A – Cost-Based Payment Process and Principles [PDF, 100KB]
- Chapter 18b – Subchapter B – Payment Principles for Cost-Based HMOs and CMPs [PDF, 168KB]
- Chapter 18c – Subchapter C – Cost Apportionment for Cost-Based HMO/CMPs [PDF, 145KB]
- Chapter 21 – Compliance Program Guidelines and Prescription Drug Benefit Manual Chapter 9 – Compliance Program Guidelines [PDF, 289KB]
- Help with File Formats and Plug-Ins
Related Links
Child Pages
War Dogs Movie Trailer –
I feel that CMS wants to put agents in jail for the smallest infraction…
AEY’s plans ran into trouble in April, 2007, when they discovered that the 7.62 mm ammunition they had planned to buy from the Albanian Ministry of Defense was actually manufactured in Communist China. Following the Tien An Minh Square massacre, the United States Government had enacted an arms embargo that precluded purchases of ammunition made by any entity that was part of Communist China’s military establishment.
A clause noting this prohibition and precluding supplying the contract with Chinese-made ammunition was included prominently
[The AHIP and Insurance Company Training we get – IMHO is defective – It doesn’t reference the actual law or CMS Rule!] in the Army’s contract with AEY. Justice.Gov
I’d have to re review everything. There may have been some improvement
#Understanding Medicare Advantage Plans (PDF) #12026
Insurance Companies get a fee from the Federal Government, when you enroll in an MAPD plan.
That's why the premium is very low or ZERO!
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Everything you want to know - Read Along
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Capitalist – Not Communist
G-d Father Emilio Barzini: [during a meeting with the Five Families] Times have changed. It’s not like the Old Days, when we can do anything we want. A refusal is not the act of a friend. If Don Corleone had all the judges, and the politicians in New York, then he must share them, or let us others use them. He must let us draw the water from the well. Certainly he can present a bill for such services; after all… we are not Communists. imdb.com
CA Insurance Code 787 (i) All advertisements used by agents, producers, brokers, solicitors, or other persons for a policy of an insurer shall have written approval of the insurer before they may be used.