Helpful Resources

It can be a challenge to find relevant resources about regulation and oversight of health plans for Medicare beneficiaries. Here’s a place to start.

Medicare Part C – Medicare Advantage

REGULATIONS

• Medicare Advantage Program Regulations 42 C.F.R. Part 422 on e-CFR

CMS MANUAL

• Medicare Managed Care Manual

Medicare Part D Prescription Drug Plans

REGULATIONS

• Part D Program Regulations 42 C.F.R. Part 423 on e-CFR

CMS MANUAL

• Prescription Drug Benefit Manual

Medicare Part C and D Audits and Enforcements

AUDITS

• Part C and D Compliance and Audit

ENFORCEMENT

• Enforcement Actions Against Part C and D Plans

Medicare Supplement (Medigap)

• NAIC Model Rule for Regulation of Medicare Supplemental Plans in April 24, 2009 Federal Register Notice
• NAIC Senior Issues Task Force (See link on right of page for 2010 Medigap Changes and Implementation)
• North Carolina’s 2005 Incorporation by Reference of NAIC Model Rule for Medicare Supplemental Plans

Medicaid Managed Care

• Medicaid Managed Care Rule