US · guidance
CMS Pub. 100-16, ch. 4, § 50.2
Cost-sharing for In Network Preventive Services
MA plans are required to cover without cost-sharing all in-network Medicare-covered
preventive services for which there is no cost-sharing under original Medicare (42 CFR
§422.100(k)). Plans are responsible for monitoring CMS’ National Coverage
Determinations and publications in order to ensure they are offering, in a timely manner,
all Medicare Part A and Part B services, including the zero cost-sharing preventive
services.
MA plans may not charge for facility fees, professional services, or physician office visits
if the only service(s) provided during the visit is a preventive service that is covered at
zero cost-sharing under original Medicare. However, if during provision of the preventive
service, additional non-preventive services are furnished, then the plan’s cost-sharing
standards apply.
Enrollees of a plan may directly access (through self-referral to any plan participating
provider) in-network screening mammography and influenza vaccine.
Please see section 90 of this chapter for information on National Coverage
Determinations (NCDs) which describes the requirements for plan compliance with new
NCDs, as well as website resources for monitoring NCDs.
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
042b5ab1cf11b98cab59a36faa950c57b4934af1fbb42a7c93bd6acc5a7561dc
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