Compliance, Rules & Regulations

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People with Medicare, family members, and caregivers should visit Medicare.gov, the Official U.S. Government Site for People with Medicare, for the latest information on Medicare enrollment, benefits, and other helpful tools.

 

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Managed Care Marketing

This section includes useful information to help Medicare Advantage Plans, Medicare Advantage Prescription Drug Plans, Prescription Drug Plans, and 1876 Cost Plans with marketing efforts.

Marketing questions should be directed to Account Managers, Marketing Reviewers, or the Marketing Mailbox atmarketing@cms.hhs.gov.

CMS-State Collaboration Activities

The Centers for Medicare & Medicaid Services (CMS) as a part of our agreement to share information and collaborate on oversight issues with the State Departments of Insurance (DOIs), has strengthened protections for particularly vulnerable beneficiaries. CMS and participating State DOIs have signed a joint letter to educate and protect residents of low income senior and Independent Care for the Mentally Retarded and the Mentally Retarded and Developmentally Disabled (ICF/MR) housing facilities concerning inappropriate behavior of agents. In this letter, we urge facility administrators to be vigilant in reporting suspect Medicare Advantage and Prescription Drug plan marketing. We also describe Medicare and Medicaid patient rights and protections relative to agent behaviors as afforded under MIPPA. CMS continues to work collaboratively with the States where the sharing of information will not only strengthen State and Federal oversight efforts, but provide more protection for Medicare beneficiaries.

 

Marketing Models, Standard Documents, and Educational Material

This section includes standardized outreach and educational material for Medicare Advantage Plans, Medicare Advantage Prescription Drug Plans, Prescription Drug Plans, and 1876 Cost Plans.

Agent/Broker Training & Testing Guidelines

View the Agent/Broker Training & Testing Guidelines in the Downloads section below. Agent/Broker Training & Testing Guidelines are posted for Plans/Part D sponsors to use at a minimum, and is a high-level breakdown of the criteria for development of individual training and testing for agents/brokers.

CMS Model Marketing Materials

View the model marketing materials in the Downloads section below. Model marketing materials include: the standardized Annual Notice of Change (ANOC) and Evidence of Coverage (EOC) templates and instructions, ANOC/EOC Errata, and Provider Directory.

Part C Explanation of Benefits (EOB) Materials

View the Part C EOB materials in the Downloads section below. These materials include the HPMS memorandum titled, “Updates Regarding Final Part C EOB Model Templates and Implementation of the Part C EOB,” the final templates and instructions, and Frequently Asked Questions regarding the Part C EOB requirements for Medicare Advantage Organizations, effective April 1, 2014.

Downloads

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