CMS Pub. 100-16, ch. 4, § 120.1

An MAO may contract with employers, unions, or State Medicaid Agencies to pay for

benefits that complement those that an employee or retiree receives under an MA plan

(see 42 CFR §422.106(a)(2)). Some examples of complementary benefits include the

following:

• The employer, union or State Medicaid Agency pays, or is financially responsible, for

some, or all, of the MA plan’s basic premiums, supplemental premiums, or cost-sharing;

• The employer, union, or State Medicaid Agency provides other employer-sponsored

(or state-sponsored) services that may require additional premium and cost-sharing;

or

• The employer, union or State Medicaid Agency purchases a non-Part D drug benefit

from the MAO.

These complementary benefits may not be classified as MA benefits and therefore are not

regulated or reviewed by CMS. However, the MAO must comply with all state

regulations governing such benefits. Refer to chapter 9, “Employer/Union Group Health

Plans,” of the MMCM, for further information.