US · guidance
CMS Pub. 100-16, ch. 4, § 10.1
General Requirements
These guidelines reflect CMS’ current interpretation of the provisions of the Medicare
Advantage statute and regulations (chapter 42 of the Code of Federal Regulations, part
422) pertaining to benefits and beneficiary protections. This guidance is subject to
change as technology and industry practices in plan design and administration evolve and
as CMS gains additional experience administering the MA program.
This chapter is governed by regulations set forth at 42 CFR 422, Subpart C, and is
generally limited to the benefits offered under Medicare Part C of the Social Security
Act. Guidance on cost plans may be found in Subpart F of chapter 17 of the Medicare
Managed Care Manual (MMCM). Guidance on Part D requirements may be found in the
Prescription Drug Benefit Manual located at: http://www.cms.gov/Medicare/Prescription-Drug-Coverage/PrescriptionDrugCovContra/PartDManuals.html. Part D prescription
drug coverage is defined at 42 CFR 423.100 and in chapter 5 of the Prescription Drug
Benefit Manual.
History
(Rev. 121, Issued: 04-22-16, Effective: 04-22-16, Implementation: 04-22-16)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
5ee9a845a81c2fd006836520cb2c6ea4a5aeeab8422f4edf2b7268ba588b295f
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