Providing information to promote informed choice

The Secretary shall provide for activities under this subsection to broadly disseminate information to medicare beneficiaries (and prospective medicare beneficiaries) on the coverage options provided under this section in order to promote an active, informed selection among such options.

(A) Open season notification At least 15 days before the beginning of each annual, coordinated election period (as defined in subsection (e)(3)(B)), the Secretary shall mail to each Medicare+Choice eligible individual residing in an area the following: (i) General information The general information described in paragraph (3). (ii) List of plans and comparison of plan options A list identifying the Medicare+Choice plans that are (or will be) available to residents of the area and information described in paragraph (4) concerning such plans. Such information shall be presented in a comparative form. (iii) Additional information Any other information that the Secretary determines will assist the individual in making the election under this section. The mailing of such information shall be coordinated, to the extent practicable, with the mailing of any annual notice under section 1395b–2 of this title .

(B) Notifications required (i) Notification to newly eligible Medicare Advantage eligible individuals To the extent practicable, the Secretary shall, not later than 30 days before the beginning of the initial Medicare+Choice enrollment period for an individual described in subsection (e)(1), mail to the individual the information described in subparagraph (A). (ii) Notification related to certain deemed elections The Secretary shall require a Medicare Advantage organization that is offering a Medicare Advantage plan that has been converted from a reasonable cost reimbursement contract pursuant to section 1395mm(h)(5)(C)(iv) of this title to mail, not later than 30 days prior to the first day of the annual, coordinated election period under subsection (e)(3) of a year, to any individual enrolled under such contract and identified by the Secretary under subsection (c)(4)(D) for such year— (I) a notification that such individual will, on such day, be deemed to have made an election with respect to such plan to receive benefits under this subchapter through an MA plan or MA–PD plan (and shall be enrolled in such plan) for the next plan year under subsection (c)(4)(A), but that the individual may make a different election during the annual, coordinated election period for such year; (II) the information described in subparagraph (A); (III) a description of the differences between such MA plan or MA–PD plan and the reasonable cost reimbursement contract in which the individual was most recently enrolled with respect to benefits covered under such plans, including cost-sharing, premiums, drug coverage, and provider networks; (IV) information about the special period for elections under subsection (e)(2)(F); and (V) other information the Secretary may specify.

(C) Form The information disseminated under this paragraph shall be written and formatted using language that is easily understandable by medicare beneficiaries.

(D) Periodic updating The information described in subparagraph (A) shall be updated on at least an annual basis to reflect changes in the availability of Medicare+Choice plans and the benefits and Medicare+Choice monthly basic and supplemental beneficiary premiums for such plans.

General information under this paragraph, with respect to coverage under this part during a year, shall include the following:

(A) Benefits under original medicare fee-for-service program option A general description of the benefits covered under the original medicare fee-for-service program under parts A and B, including— (i) covered items and services, (ii) beneficiary cost sharing, such as deductibles, coinsurance, and copayment amounts, and (iii) any beneficiary liability for balance billing.

(B) Election procedures Information and instructions on how to exercise election options under this section.

(C) Rights A general description of procedural rights (including grievance and appeals procedures) of beneficiaries under the original medicare fee-for-service program and the Medicare+Choice program and the right to be protected against discrimination based on health status-related factors under section 1395w–22(b) of this title .

(D) Information on medigap and medicare select A general description of the benefits, enrollment rights, and other requirements applicable to medicare supplemental policies under section 1395ss of this title and provisions relating to medicare select policies described in section 1395ss(t) of this title .

(E) Potential for contract termination The fact that a Medicare+Choice organization may terminate its contract, refuse to renew its contract, or reduce the service area included in its contract, under this part, and the effect of such a termination, nonrenewal, or service area reduction may have on individuals enrolled with the Medicare+Choice plan under this part.

(F) Catastrophic coverage and single deductible In the case of an MA regional plan, a description of the catastrophic coverage and single deductible applicable under the plan.

Information under this paragraph, with respect to a Medicare+Choice plan for a year, shall include the following:

(A) Benefits The benefits covered under the plan, including the following: (i) Covered items and services beyond those provided under the original medicare fee-for-service program. (ii) Any beneficiary cost sharing, including information on the single deductible (if applicable) under section 1395w–27a(b)(1) of this title . (iii) Any maximum limitations on out-of-pocket expenses. (iv) In the case of an MSA plan, differences in cost sharing, premiums, and balance billing under such a plan compared to under other Medicare+Choice plans. (v) In the case of a Medicare+Choice private fee-for-service plan, differences in cost sharing, premiums, and balance billing under such a plan compared to under other Medicare+Choice plans. (vi) The extent to which an enrollee may obtain benefits through out-of-network health care providers. (vii) The extent to which an enrollee may select among in-network providers and the types of providers participating in the plan’s network. (viii) The organization’s coverage of emergency and urgently needed care.

(B) Premiums (i) In general The monthly amount of the premium charged to an individual. (ii) Reductions The reduction in part B premiums, if any.

(C) Service area The service area of the plan.

(D) Quality and performance To the extent available, plan quality and performance indicators for the benefits under the plan (and how they compare to such indicators under the original medicare fee-for-service program under parts A and B in the area involved), including— (i) disenrollment rates for medicare enrollees electing to receive benefits through the plan for the previous 2 years (excluding disenrollment due to death or moving outside the plan’s service area), (ii) information on medicare enrollee satisfaction, (iii) information on health outcomes, and (iv) the recent record regarding compliance of the plan with requirements of this part (as determined by the Secretary).

(E) Supplemental benefits Supplemental health care benefits, including any reductions in cost-sharing under section 1395w–22(a)(3) of this title and the terms and conditions (including premiums) for such benefits.

(F) Provider directory Beginning with plan years beginning on or after January 1, 2029 , in the case of a specified MA plan (as defined in section 1395w–22(c)(3)(C) of this title ), the accuracy score of the plan’s provider directory (as reported under section 1395w–27(e)(6)(A)(ii) of this title ) listed prominently on the plan’s provider directory.

The Secretary shall maintain a toll-free number for inquiries regarding Medicare+Choice options and the operation of this part in all areas in which Medicare+Choice plans are offered and an Internet site through which individuals may electronically obtain information on such options and Medicare+Choice plans.

A Medicare+Choice organization shall provide the Secretary with such information on the organization and each Medicare+Choice plan it offers as may be required for the preparation of the information referred to in paragraph (2)(A).