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 at marketing@cms.hhs.gov.
A Health Care Pre-Payment Plan (HCPP) is an organization is a union or employer sponsored plan that provides or arranges for some or all of Part B Medicare benefits on a prepayment basis. Payment for Part A services is made on a fee-for-service basis. Organizations that are interested in applying for a HCPP contract must download and complete all of the files below.
This page contains information for current and future contracting Medicare Advantage (MA) organizations, other Medicare managed care health plans, and additional parties interested in the operational and regulatory aspects of the MA program.
Get more coverage, once you have Part A and/or Part B.
This page discusses the enrollees right to request a Part D coverage determination, appeal or file a grievance/complaint. Individuals who represent enrollees may either be appointed or authorized to act on behalf of the enrollee in filing a grievance, requesting an initial determination, or in dealing with any of the levels of the appeals process. For more information about appointing a representative, see section 20 in the Parts C & D Enrollee Grievances, Organization/Coverage Determinations, and Appeals Guidance.
This section contains information on eligibility for the Low-Income Subsidy (also called “Extra Help”) available under the Medicare Part D prescription drug program. It includes information on those who are automatically deemed eligible, as well as those who must apply to be determined eligible. There is also a section on how individuals are re-determined eligible for the low-income subsidy. Lastly, this section contains a notice to State Medicaid Directors informing them of the reassignment process impacting the Part D enrollment of certain low income individuals in their state.
Full guide to Limited Income and Resources
The retiree drug subsidy (RDS) is one of several options available under Medicare that enables employers and unions to continue assisting their Medicare eligible retirees in obtaining more generous drug coverage. It is generally considered the easiest and most straightforward of the available options, and can often be implemented with little or no benefit design changes to current coverage. The primary web site for the RDS program, including the online tool for submitting subsidy applications, is hosted by the RDS Center (see link below under “Related Links Outside of CMS”). This page provides links to guidance and application instruction documents relating to the RDS, as well as overview documents.
As a condition of payment, all Part D plans must submit data and information necessary for CMS to carry out the payment provisions of the MMA. This section contains content on how CMS will implement the statutory payment mechanisms by collecting a limited subset of data elements on 100 percent of prescription drug “claims” or events.
The Medicare Modernization Act (MMA) requires entities (whose policies include prescription drug coverage) to notify Medicare eligible policyholders whether their prescription drug coverage is creditable coverage, which means that the coverage is expected to pay on average as much as the standard Medicare prescription drug coverage. For these entities, there are two disclosure requirements:
