US · guidance
CMS Pub. 100-16, ch. 9, § 20.2
Actuarial Swapping of Part C Benefits Not Covered By Original
Medicare
(Rev. 111, 05-03-13, Effective: 05-03-13, Implementation: 05-03-13)
MAOs may swap different types of Part C supplemental benefits not covered under Original
Medicare that are of equal actuarial value for employer/union group plan sponsors. The swaps
may be used if an employer/union prefers to offer a different benefit package to its members than
the MAO offers to individual beneficiaries under the MA plan.
Example: An employer may prefer to offer a vision benefit to its employees rather than the
dental benefit the MAO offers to individual beneficiaries. The MAO may design a vision
benefit for the employer that has equal actuarial value to the dental benefit and swap these
benefits in the plan it offers to the employer.
MAOs do not need to obtain specific, advance approval from CMS in order to take advantage of
actuarial swapping for particular employer/union group plan sponsors.
History
(Rev. 111, 05-03-13, Effective: 05-03-13, Implementation: 05-03-13)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
442bb19dd700e872b71b312880c1616ba4240922154211f3011dee5fa567a6b8
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