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Guidance resources for health plans preparing their Plan Benefit Packages (PBPs) for Part C benefits

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<div class="row"><div class="col-lg-4 col-sm-12 text-center" id="guidance"><a data-parent="#detail-panel-group" data-target="#guidance-detail-section" data-toggle="collapse"><img alt="Guidance" class="img-circle if-collapsed" data-holder-rendered="true" height="93" src="/mabenefitsmailbox/Content/lmi/images/guidance01.png" width="93" /><img alt="Guidance" class="img-circle if-not-collapsed" data-holder-rendered="true" height="93" src="/mabenefitsmailbox/Content/lmi/images/minus_icon.png" width="93" /></a><h3><a data-parent="#detail-panel-group" data-target="#guidance-detail-section" data-toggle="collapse">Guidance</a></h3><p>CMS guidance documents related to Part C benefits policy.</p></div><div class="col-lg-4 col-sm-12 text-center" id="questions"><a class="collapsed" data-parent="#detail-panel-group" data-target="#questions-detail-section" data-toggle="collapse"><img alt="Questions & Answers" class="img-circle if-collapsed" data-holder-rendered="true" height="93" src="/mabenefitsmailbox/Content/lmi/images/questions01.png" width="93" /><img alt="Questions & Answers" class="img-circle if-not-collapsed" data-holder-rendered="true" height="93" src="/mabenefitsmailbox/Content/lmi/images/minus_icon.png" width="93" /></a> <h3><a data-parent="#detail-panel-group" data-target="#questions-detail-section" data-toggle="collapse">Questions &amp; Answers</a></h3><p>Answers to previously asked questions.</p></div><div class="col-lg-4 col-sm-12 text-center" id="resources"><a class="collapsed" data-parent="#detail-panel-group" data-target="#resources-detail-section" data-toggle="collapse"><img alt="Resources" class="img-circle if-collapsed" data-holder-rendered="true" height="93" src="/mabenefitsmailbox/Content/lmi/images/resources01.png" width="93" /><img alt="Resources" class="img-circle if-not-collapsed" data-holder-rendered="true" height="93" src="/mabenefitsmailbox/Content/lmi/images/minus_icon.png" width="93" /></a> <h3><a data-parent="#detail-panel-group" data-target="#resources-detail-section" data-toggle="collapse">Resources</a> </h3><p>Resources if your questions do not relate to Part C benefits policy.</p></div></div>

Guidance

CMS guidance documents related to Part C benefits policy.

Questions & Answers

Answers to previously asked questions.

Resources

Resources if your questions do not relate to Part C benefits policy.

Please review the available guidance documents and the resources below that may answer your question.

(Optional) Select a previous version:

<div id="detailsContainer"><div class="ma-details-row"><p><strong><em></em></strong><strong><em></em></strong><strong><em>Contract Year 2025</em></strong></p><p style="margin-left:30px;"><a href="/MABenefitsMailbox/S3Browser/GetFile?path=Updates%20and%20Timeline%20for%20Contract%20Year%202025%20Plan%20Benefit%20Package%20(December%201%2C%202023).pdf"></a><a href="/MABenefitsMailbox/S3Browser/GetFile?path=Federal%20Regulation%20Contract%20Year%202025%20Medicare%20Advantage%20and%20Part%20D%20Final%20Rule_04042024.pdf">Federal Regulation Contract Year 2025 Medicare Advantage and Part D Final Rule (04/04/2024)</a></p><p style="margin-left:30px;"><a href="/MABenefitsMailbox/S3Browser/GetFile?path=Preliminary%20CY%202025%20Part%20C%20Bid%20Review%20Memorandum_22124.pdf">Preliminary Contract Year 2025 Standards for Part C Benefits, Bid Review and Evaluation (02/21/2024)</a></p><p style="margin-left:30px;"><a href="/MABenefitsMailbox/S3Browser/GetFile?path=Updates%20and%20Timeline%20for%20Contract%20Year%202025%20Plan%20Benefit%20Package%20(December%201%2C%202023).pdf">Updates and Timeline for Contract Year 2025 Plan Benefit Package (12/01/2023)</a></p><p style="margin-left:30px;"><a href="/MABenefitsMailbox/S3Browser/GetFile?path=CY%202024%20Part%20C%20and%20Part%20D%20Baseline%20OOPC%20Models.pdf">Contract Year 2024 Part C and Part D Baseline Out-of-Pocket Cost Models (12/19/2023)<br /><br /></a></p><p><strong><em>Contract Year 2024</em></strong></p><p style="margin-left:30px;"><strong><em></em></strong><a href="/MABenefitsMailbox/S3Browser/GetFile?path=Final%20CY%202024%20Part%20C%20Bid%20Review%20Memo.pdf" target="_blank" title="Final Contract Year (CY) 2024 Standards for Part C Benefits, Bid Review, and Evaluation">Final Contract Year CY 2024 Standards for Part C Benefits, Bid Review, and Evaluation (04/14/2023)</a></p><p style="margin-left:30px;"><a href="/MABenefitsMailbox/S3Browser/GetFile?path=Total%20Beneficiary%20Cost%20Data%20for%20CY%202024%20Bid%20Preparation_04_20_2023.pdf" target="_blank" title="Total Beneficiary Cost Data for CY 2024 Bid Preparation (04/20/2023)">Total Beneficiary Cost Data for CY 2024 Bid Preparation (04/20/2023)</a></p><p style="margin-left:30px;"><a href="/MABenefitsMailbox/S3Browser/GetFile?path=Update%20Regarding%20CY%202024%20Part%20C%20Bid%20Review%20OOPC%20Model.pdf" target="_blank" title="Update Regarding CY 2024 Part C Bid Review OOPC Model">Update Regarding CY 2024 Part C Bid Review OOPC Model (05/16/2023)</a></p><p style="margin-left:30px;"><a href="/MABenefitsMailbox/S3Browser/GetFile?path=CY%202024%20Part%20C%20Bid%20Review%20OOPC%20Model.pdf">Update Regarding Contract Year 2024 Part C Bid Review Out-of-Pocket Cost Model (07/24/2023)</a></p><p style="margin-left:30px;"><a href="/MABenefitsMailbox/S3Browser/GetFile?path=IRA%20Part%20B%20Rebatable%20Drugs%20and%20Insulin%20FAQs.pdf">IRA Part B Rebatable Drugs and Insulin FAQs (07/13/2023)</a></p><p><em><strong><br />Recent Regulations</strong></em></p><ul style="list-style-type:none;"><li style="margin:10px 0;"><a href="/MABenefitsMailbox/S3Browser/GetFile?path=CY2023%20Part%20C%20IRA%20Memorandum%2011-7-2022.pdf" target="_blank">CY 2023 Part C IRA Memorandum (11/07/2022)</a></li><li style="margin:10px 0;"><a href="https://www.federalregister.gov/documents/2022/04/14/2022-07642/medicare-program-maximum-out-of-pocket-moop-limits-and-service-category-cost-sharing-standards" target="_blank">Contract Year 2023 Medicare Advantage Maximum Out-of-Pocket Limits and Service Category Cost Sharing Standards Final Rule with Comment Period (CMS-4190-FC4) (04/14/2022)</a></li><li style="margin:10px 0;"><a href="https://www.federalregister.gov/documents/2021/01/19/2021-00538/medicare-and-medicaid-programs-contract-year-2022-policy-and-technical-changes-to-the-medicare" target="_blank">Medicare and Medicaid Programs; Contract Year 2022 Policy and Technical Changes to the Medicare Advantage Program, Medicare Prescription Drug Benefit Program, Medicaid Program, Medicare Cost Plan Program, and Programs of All-Inclusive Care for the Elderly (CMS-4190-F2) (01/19/2021)</a></li><li style="margin:10px 0;"><a href="https://www.federalregister.gov/documents/2020/06/02/2020-11342/medicare-program-contract-year-2021-policy-and-technical-changes-to-the-medicare-advantage-program" target="_blank">Medicare Program; Contract Year 2021 Policy and Technical Changes to the Medicare Advantage Program, Medicare Prescription Drug Benefit Program, and Medicare Cost Plan Program (CMS-4190-F1) (06/02/20)</a></li></ul><p><strong><em><br />Contract Year 2023</em></strong></p><ul style="list-style-type:none;"><li style="margin:10px 0px;"><a href="https://askmarty2.lmi.org/MABenefitsMailbox/S3Browser/GetFile?path=Medicare%20and%20You%202023.pdf">Medicare and You 2023</a></li><li style="margin:10px 0px;"><span class="ui-provider uh b c d e f g h i j k l m n o p q r s t u v w x y z ab ac ae af ag ah ai aj ak" dir="ltr"><a href="/MABenefitsMailbox/S3Browser/GetFile?path=CY2023%20Part%20C%20IRA%20Memorandum%2011-7-2022.pdf">CY 2023 Part C IRA Memorandum (11/07/2022)</a></span></li><li style="margin:10px 0px;"><a href="https://askmarty2.lmi.org/MABenefitsMailbox/S3Browser/GetFile?path=Final%20CY%202023%20Part%20C%20Bid%20Review%20Eval%20Memorandum.pdf">Final Contract Year 2023 Part C Benefits Review and Evaluation (04/20/2022)</a><br /></li><li style="margin:10px 0px;"><a href="https://askmarty2.lmi.org/MABenefitsMailbox/S3Browser/GetFile?path=Release%20of%20CY%202023%20Bid%20Review%20OOPC%20Model.pdf">Contract Year 2023 Bid Review Out-of-Pocket Cost Models (04/08/2022)</a></li><li style="margin:10px 0px;"><a href="https://askmarty2.lmi.org/MABenefitsMailbox/S3Browser/GetFile?path=CY2023_PBP-BPT_Release_and_800-series_Memo_03232022_final.pdf">Release of the 2023 Plan Benefit Package and Bid Pricing Tool Software and Related Technical Bidding Guidance for Employer/Union-Only Group Waiver Plans (04/08/2022)</a></li><li style="margin:10px 0px;"><a href="https://askmarty2.lmi.org/MABenefitsMailbox/S3Browser/GetFile?path=CY23%20D-SNP%20lookalike%20Transition%20HPMS%20Memo_Final.pdf">Dual Eligible Special Needs Plan &ldquo;Look-Alike&rdquo; Transitions for Contract Year 2023 (04/07/2022)</a></li><li style="margin:10px 0px;"><a href="https://askmarty2.lmi.org/MABenefitsMailbox/S3Browser/GetFile?path=2023%20Rate%20Announcement%20FINAL_4.4.2022_508.pdf">Announcement of Calendar Year (CY) 2023 Medicare Advantage (MA) Capitation Rates and Part C and Part D Payment Policies (04/04/2022)</a></li><li style="margin:10px 0px;"><a href="https://askmarty2.lmi.org/MABenefitsMailbox/S3Browser/GetFile?path=Updated%20CY%202022%20Part%20C%20and%20Part%20D%20Baseline%20OOPC%20Model%20Values.pdf">Updated CY 2022 Part C and Part D Baseline OOPC Model Values (02/07/2022)</a></li><li style="margin:10px 0px;"><a href="https://askmarty2.lmi.org/MABenefitsMailbox/S3Browser/GetFile?path=CY%202022%20Part%20C%20and%20Part%20D%20Baseline%20OOPC%20Models.pdf">Contract Year 2022 Part C and Part D Baseline Out-of-Pocket Cost Models (12/30/2021)</a></li><li style="margin:10px 0px;"><a href="https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/preventive-services/medicare-wellness-visits.html" target="_blank">Medicare Wellness Visits (Initial Preventive Physical Exam and Annual Wellness Visit)</a></li></ul><p><br /><strong><em>Contract Year 2022</em></strong></p><ul style="list-style-type:none;"><li style="margin:10px 0;"><a href="https://www.medicare.gov/Pubs/pdf/10050-Medicare-and-You.pdf" target="_blank">Medicare and You 2022</a></li><li style="margin:10px 0;"><a href="https://askmarty2.lmi.org/MABenefitsMailbox/S3Browser/GetFile?path=2022_FINAL%20CY%202022%20Part%20C%20Bid%20Review%20Memo.pdf" target="_blank">Final Contract Year 2022 Part C Benefits Review and Evaluation (05/20/2021)</a></li><li style="margin:10px 0;"><a href="https://askmarty2.lmi.org/MABenefitsMailbox/S3Browser/GetFile?path=2022_CY%202022%20MA%20Bid%20Technical%20Inst%2005-12-2021.pdf" target="_blank">Contract Year 2022 Medicare Advantage Technical Instructions (05/12/2021)</a></li><li style="margin:10px 0;"><a href="https://www.cms.gov/files/document/addendum-2022-announcement.pdf" target="_blank">Addendum to Announcement of Calendar Year (CY) 2022 Medicare Advantage (MA) Capitation Rates and Part C and Part D Payment Policies: List of Private Fee-for-Service Network Areas for 2023 (03/29/2021)</a></li><li style="margin:10px 0;"><a href="https://www.cms.gov/files/document/2022-announcement.pdf" target="_blank">Announcement of Calendar Year (CY) 2022 Medicare Advantage (MA) Capitation Rates and Part C and Part D Payment Policies (01/15/2021)</a></li></ul><p><em><strong><br />Other Reference Material</strong></em></p><ul style="list-style-type:none;"><li style="margin:10px 0;"><a href="https://askmarty2.lmi.org/MABenefitsMailbox/S3Browser/GetFile?path=Supplemental%20Benefits%20for%20Chronically%20Ill%20Memo%20(April%2024%2C%202019).pdf" target="_blank">Implementing Supplemental Benefits for Chronically Ill Enrollees (04/24/2019)</a></li><li style="margin:10px 0;"><a href="https://askmarty2.lmi.org/MABenefitsMailbox/S3Browser/GetFile?path=2020_HPMS%20Memo%20-%20Reinterpretation%20of%20the%20%20Uniformity%20Requirement%204-27-18.pdf" target="_blank">Reinterpretation of the Uniformity Requirement (04/27/2018)</a></li><li style="margin:10px 0;"><a href="https://askmarty2.lmi.org/MABenefitsMailbox/S3Browser/GetFile?path=2020_HPMS%20Memo%20Primarily%20Health%20Related%204-27-18.pdf" target="_blank">Reinterpretation of &ldquo;Primarily Health Related&rdquo; for Supplemental Benefits (04/27/2018)</a></li><li style="margin:10px 0;"><a href="http://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Internet-Only-Manuals-IOMs-Items/CMS019326.html?DLPage=2&amp;DLSort=0&amp;DLSortDir=ascending" target="_blank">Medicare Managed Care Manuals</a></li><li style="margin:10px 0;"><a href="http://www.cms.gov/Medicare/Prescription-Drug-Coverage/PrescriptionDrugCovGenIn/OOPCResources.html" target="_blank">OOPC Resources</a></li></ul></div></div>

Contract Year 2025

Federal Regulation Contract Year 2025 Medicare Advantage and Part D Final Rule (04/04/2024)

Preliminary Contract Year 2025 Standards for Part C Benefits, Bid Review and Evaluation (02/21/2024)

Updates and Timeline for Contract Year 2025 Plan Benefit Package (12/01/2023)

Contract Year 2024 Part C and Part D Baseline Out-of-Pocket Cost Models (12/19/2023)

Contract Year 2024

Final Contract Year CY 2024 Standards for Part C Benefits, Bid Review, and Evaluation (04/14/2023)

Total Beneficiary Cost Data for CY 2024 Bid Preparation (04/20/2023)

Update Regarding CY 2024 Part C Bid Review OOPC Model (05/16/2023)

Update Regarding Contract Year 2024 Part C Bid Review Out-of-Pocket Cost Model (07/24/2023)

IRA Part B Rebatable Drugs and Insulin FAQs (07/13/2023)

Recent Regulations

Contract Year 2023

Contract Year 2022

Other Reference Material

Answers to previously asked questions

Coming soon

Following are available resources if your questions do not relate to Part C benefits policy:

(Optional) Select a previous version:

<div id="detailsContainer"><div class="ma-details-row"><p>Questions specifically related to the Medicare FFS Average Sales Price (ASP) files may be directed to: <a href="mailto:Sec303ASPdata@cms.hhs.gov">Sec303ASPdata@cms.hhs.gov</a></p><div class="ma-details-row"><p>If your question is regarding the Inflation Reduction Act, please submit the question to:&nbsp;<a href="mailto:IRARebateandNegotiation@cms.hhs.gov">IRARebateandNegotiation@cms.hhs.gov</a>&nbsp;</p></div><div class="ma-details-row"><p>Policy related fiscal soundness questions, please submit an e-mail to:&nbsp;<a href="mailto:FinancialReview@cms.hhs.gov&gt;FinancialReview@cms.hhs.gov&lt;/a&gt; &lt;/p&gt; &lt;p&gt;Technical HPMS questions (e.g., PBP download, plan creation, bid upload), please contact the HPMS Help Desk at 1-800-220-2028 or &lt;a href=">FinancialReview@cms.hhs.gov</a></p></div><div class="ma-details-row"><p>Technical questions about the Out-of-Pocket Cost (OOPC) model, please submit an email to:&nbsp;<a href="mailto:OOPC@cms.hhs.gov?subject=Technical OOPC questions">OOPC@cms.hhs.gov</a> </p></div><div class="ma-details-row"><p>Part D benefits questions, please submit an email to:&nbsp;<a href="mailto:partdbenefits@cms.hhs.gov?subject=Part D Benefit question">partdbenefits@cms.hhs.gov</a><br /></p></div><div class="ma-details-row"><p>Bid Pricing Tool (BPT) questions, please submit an email to:&nbsp;<a href="mailto:actuarial-bids@cms.hhs.gov">actuarial-bids@cms.hhs.gov</a></p></div><div class="ma-details-row"><p>Medicare Medicaid Program,&nbsp;please submit an email to:&nbsp;<a href="mailto:mmcocapsmodel@cms.hhs.gov">mmcocapsmodel@cms.hhs.gov</a></p></div><div class="ma-details-row"><p>Part C Medicare Advantage policy questions, please submit an inquiry via:&nbsp;<a href="https://dpap.lmi.org/DPAPMailbox/">https://dpap.lmi.org/DPAPMailbox/</a> <a href="https://dpap.lmi.org/DPAPMailbox/"></a></p></div><div class="ma-details-row"><p>Medicare Advantage Value-Based Insurance Design (MA-VBID) model questions, please submit an e-mail to:&nbsp;<a href="mailto:VBID@cms.hhs.gov">VBID@cms.hhs.gov</a></p></div><div class="ma-details-row"><p>Risk adjustment questions can be directed to <a href="mailto:riskadjustmentoperations@cms.hhs.gov" tabindex="-1" target="_blank" title="riskadjustmentoperations@cms.hhs.gov"><span>riskadjustmentoperations@cms.hhs.gov</span></a></p></div><div class="ma-details-row"><p>Appeals Policy questions, please submit inquiry via: <a href="https://appeals.lmi.org/" target="_blank" title="https://appeals.lmi.org/">https://appeals.lmi.org/</a></p></div><div class="ma-details-row"><p>Enrollment and Eligibility Policy questions, please submit inquiry via: <a href="https://enrollment.lmi.org/" tabindex="-1" target="_blank" title="https://enrollment.lmi.org"><span>https://enrollment.lmi.org</span></a></p></div></div></div>

Questions specifically related to the Medicare FFS Average Sales Price (ASP) files may be directed to: Sec303ASPdata@cms.hhs.gov

If your question is regarding the Inflation Reduction Act, please submit the question to: IRARebateandNegotiation@cms.hhs.gov

Policy related fiscal soundness questions, please submit an e-mail to: FinancialReview@cms.hhs.gov

Technical questions about the Out-of-Pocket Cost (OOPC) model, please submit an email to: OOPC@cms.hhs.gov

Part D benefits questions, please submit an email to: partdbenefits@cms.hhs.gov

Bid Pricing Tool (BPT) questions, please submit an email to: actuarial-bids@cms.hhs.gov

Medicare Medicaid Program, please submit an email to: mmcocapsmodel@cms.hhs.gov

Part C Medicare Advantage policy questions, please submit an inquiry via: https://dpap.lmi.org/DPAPMailbox/

Medicare Advantage Value-Based Insurance Design (MA-VBID) model questions, please submit an e-mail to: VBID@cms.hhs.gov

Risk adjustment questions can be directed to riskadjustmentoperations@cms.hhs.gov

Appeals Policy questions, please submit inquiry via: https://appeals.lmi.org/

Enrollment and Eligibility Policy questions, please submit inquiry via: https://enrollment.lmi.org

Ask a Part C Benefits Question

Please review the available guidance documents and resources described above before submitting a question.