CMS Final Rule Part B and others

October 28, 2022

Contact: CMS Media Relations
CMS Media Inquiries

Biden-Harris Administration Strengthens Medicare with Finalized Policies to Simplify Enrollment and Expand Access to Coverage

Final rule creates Special Enrollment Periods and reduces gaps in Medicare coverage, and improves administration of the Medicare Savings Programs.

Today, the Centers for Medicare & Medicaid Services (CMS) issued a final rule that updates Medicare enrollment and eligibility rules to expand coverage for people with Medicare and advance health equity. The final rule, which implements changes made by the Consolidated Appropriations Act, 2021 (CAA), makes it easier for people to enroll in Medicare and eliminates delays in coverage. Among these changes, individuals will now have Medicare coverage the month immediately after their enrollment, thereby reducing any delays in coverage.  In addition, the rule expands access through Medicare special enrollment periods (SEPs) and allows certain eligible beneficiaries to receive Medicare Part B coverage without a late enrollment penalty.

The Biden-Harris Administration has made expanding access to health care a top priority, and, under their leadership, more Americans than ever before have health insurance coverage. Today’s final rule builds on this success and supports additional Administration efforts to strengthen Medicare.

“The Biden-Harris Administration has made it clear: we are committed to doing all we can to strengthen Medicare,” said HHS Secretary Xavier Becerra. “Today, we’re making it easier to enroll, expanding access, and eliminating delays in coverage to improve Medicare for the millions of Americans who depend on it. We’re working tirelessly to deliver the health insurance and peace of mind that enrollees deserve.”

“CMS is committed to ensuring that people eligible for Medicare have timely access to this vital coverage,” said CMS Administrator Chiquita Brooks-LaSure. “For the first time, special enrollment periods will be available in traditional Medicare for individuals who were unable to enroll due to exceptional conditions, and individuals who have had a kidney transplant will now be able to receive extended Medicare coverage for immunosuppressive drugs.  Each part of this critical rule advances CMS’ strategic vision of expanding access to quality, affordable health coverage and care.”

A Special Enrollment Period (SEP) lets individuals make changes to their health coverage outside of a typical enrollment period. The SEPs finalized in this rule provide an opportunity for eligible individuals to enroll in Part B if they didn’t enroll in Medicare during their Initial Enrollment Period when they were first eligible, and to do so without a late enrollment penalty. Examples of new SEPs created by this rule are SEPs for eligible individuals who miss an enrollment opportunity because: 1) they were impacted by a disaster or government-declared emergency; 2) their employer or health plan materially misrepresented information related to timely enrollment in Medicare Part B; 3) they were incarcerated; and 4) their Medicaid coverage was terminated after the COVID-19 PHE ends or on or after January 1, 2023 (whichever is earlier).

The final rule also establishes a new immunosuppressive drug benefit that extends vital Medicare immunosuppressive drug coverage to certain individuals who have had a kidney transplant and otherwise would lose Medicare coverage. The changes finalized in this rule go into effect on January 1, 2023.

These changes not only implement important provisions of the Consolidated Appropriations Act, 2021 (CAA), but also support President Biden’s Executive Orders on Transforming Federal Customer Experience and Service Delivery to Rebuild Trust in Government and Continuing to Strengthen Americans’ Access to Affordable, Quality Health Coverage by eliminating confusing coverage waiting periods and allowing CMS and the Social Security Administration to remedy missed enrollment periods by permitting eligible individuals to enroll in Medicare Part B through SEPs for exceptional conditions. Furthermore, these changes support the Administration’s vision for CMS: to serve the public as a trusted partner and steward, dedicated to advancing health equity, expanding access to affordable coverage and care, and improving health outcomes.

“These changes highlight CMS’ efforts to advance health equity and improve access to Medicare,” said Dr. Meena Seshamani, Deputy Administrator of CMS and Director of the Center for Medicare. “Reducing gaps in coverage, allowing for special enrollment periods for individuals in exceptional circumstances, spending money in a smarter way on kidney transplant patients – these are meaningful changes that put people at the center of their care and improve the Medicare program.”

Finally, CMS is making several technical updates to improve administration of the Medicare Savings Programs. These programs help make Medicare affordable for those struggling to afford health care.

CMS encourages people who are approaching Medicare eligibility to research their Medicare coverage options and enrollment deadlines. and 1-800-MEDICARE are both available to help people understand their choices and associated deadlines. In addition, personalized health insurance counseling is available at no cost from State Health Insurance Assistance Programs (SHIPs). Visit or call 1-800-MEDICARE for each SHIP’s phone number.

Medicare Open Enrollment runs from October 15 to December 7, 2022. During this time, people eligible for Medicare can compare 2023 coverage options on provides clear, easy-to-use information, as well as an updated Medicare Plan Finder, to allow people to compare options for health and drug coverage, which may change from year to year.

Medicare Plan Finder was updated with the 2023 Medicare health and prescription drug plan information on October 1, 2022. 1-800-MEDICARE is also available 24 hours a day, seven days a week to provide help in English and Spanish as well as language support in over 200 languages. People who want to keep their current Medicare coverage do not need to re-enroll.

During Open Enrollment, people with Medicare who take insulin are encouraged to call 1-800-MEDICARE or contact their State Health Insurance Assistance Programs ( for help comparing plans and costs this year.

To view a fact sheet on the final rule, visit:

To view the final rule, visit:

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THP: Express Scripts and Kroger Pharmacy Changes

THP AgentNewsflash communication from 10/27/22:

Express Scripts and Kroger Pharmacy Changes


As you may now know, Kroger Pharmacies will NOT be participating with Express Scripts (ESI) on 1/1/2023. As a health plan who contracts with ESI, this will impact our members. We will begin notifications next week to affected members.

Click here to find the latest updates to the 2023 Pharmacy Directory. You will see that our pharmacy network (and the preferred pharmacies within) remains robust.

NOTE: (Preferred pharmacies are marked with this symbol- ‡.)

Cigna’s New Icario Agent Portal – Important Tips

Sourced from Cigna Broker communication from 10/24/22:

Read below for tips to facilitate your transition to the new portal

On October 12, Cigna launched the new and improved Icario Connect Agent Portal. This new agent portal includes features that make it easier for you to facilitate health risk assessments (HRAs) with your customers. 

As part of the transition to the new portal, all existing agents should have received a Welcome Email from Icario inviting them to create new login credentials. We are happy that many agents have been able to transition to the new agent portal smoothly.

 For those of you who have still not activated your new agent portal, we have put together some helpful tips and resources to help you along the way. 

Registration Issues

 Agents who have not registered in the new Icario agent portal will receive daily emails from Icario with their new username and password. If you have not received the email, please check your spam folder or follow the steps below:


  1. Email Icario directly at
  2. Call our Cigna Agent Resource Line (CARL) at 866-442-7516


Password Issues

 If you are experiencing any issues with your new password (e.g., new password is not working), please follow the steps below. 

  1. Reply to the Icario Welcome Email informing Icario that your new password is not working. Icario will reach out directly to assist you.
  2. Email Icario directly at
  3. Call our Cigna Agent Resource Line (CARL) at 866-442-7516


Other Technical Issues

 If you are still experiencing technical difficulties after following the steps above, please try the following:

  • Clear the cache in your browser.
  • Disable your pop-up blocker.
  • Check your spam folder for emails from Icario.
  • Type in your new username and password to ensure accuracy (do not copy and paste from the Icario Welcome Email).
  • Use capital letters when entering the Medicare Beneficiary Identifier (MBI) on the Prospective Member screen (e.g., 1AC2-D34-EF56)


One more thing… Great News!  The deadline to submit your HRAs has been extended! Agents now have until 12/21/2022 to submit the HRA for any customer applications taken from 10/1/2022 – 12/7/2022.

Anthem Dental Expansion Update: Liberty Dental

Anthem communication as of 10/24/22:

Provider Network Expansion – More dental providers for your Medicare clients!

A network arrangement between our existing commercial participating network of dentists and LIBERTY Dental provides an expanded network for Medicare Advantage dental products effective January 1, 2023. Note: Network expansion will not include NJ and NV.



CMS Puts the Kibosh on Misleading Medicare Advantage Sales Pitches

–“Secret shoppers” found that 80% of agent calls with clients were inaccurate or insufficient

by Cheryl Clark, Contibuting Writer, MedPage Today – October 21, 2022

After reviewing thousands of complaints about “confusing, misleading, and/or inaccurate” Medicare advantage ads, and using “secret Shoppers” to document deceptive telephone sales pitches, the Centers for medicar & Medicaid services (CMS) announced it is putting its foot down on Thursday.

Read full article

CMS Marketing Best Practices + Agent Broker Marketing FAQ

DEPARTMENT OF HEALTH & HUMAN SERVICES | Centers for Medicare & Medicaid Services | Center for Medicare
DATE: October 19, 2022
TO: All Medicare Advantage Organizations and Prescription Drug Plan Sponsors
FROM: Kathryn A. Coleman Director
SUBJECT: CMS Monitoring Activities and Best Practices during the Annual Election Period

The Centers for Medicare & Medicaid Services (CMS) issues this memorandum informing Medicare Advantage (MA) organizations and Part D sponsors of CMS monitoring activities and sharing plan and sponsor best practices during the 2023 Annual Election Period (AEP), running from October 15, 2022 to December 7, 2023.

CMS is concerned about the marketing practices of all entities, including Third-Party Marketing Organizations. We have reviewed thousands of complaints and hundreds of audio calls and have identified numerous issues with information provided to beneficiaries that is confusing, misleading and/or inaccurate. CMS has conducted so-called “secret shopping” by calling numbers associated with television advertisements, mailings, newspaper advertisements, and internet searches to monitor the experience beneficiaries have engaging these entities. Our secret shopping activities have discovered that some agents were not complying with current regulation and unduly pressuring beneficiaries, as well as failing to provide accurate or enough information to assist a beneficiary in making an informed enrollment decision.  READ THE FULL RELEASE: HPMS Marketing Practices Memo

Contract Year 2023 Medicare Advantage Marketing Policies – Frequently Asked Questions
On May 9, 2022, CMS published its contract year 2023 Medicare Advantage (MA) (Part C) and Prescription Drug Benefit (Part D) final rule (87 FR 27704), wherein CMS established certain marketing and communications requirements for the Part C and Part D programs. These rules were designed to address complaints of inappropriate marketing that CMS received from beneficiaries and their caregivers. In response to a significant increase in marketing-related complaints, CMS staff reviewed numerous recordings of calls from different marketing entities, including individual agents and brokers, as well as larger call centers. The agents failed to provide the beneficiary with the necessary information or provided inaccurate information to make an informed choice for more than 80 percent of the calls reviewed. Examples included beneficiaries being told that if their medication was not on the formulary, the doctor could tell the plan and the plan would simply add it; or incorrectly stating that “nothing would change” when beneficiaries asked if their current health coverage would stay the same.
As 2023 annual open enrollment begins, CMS has received questions regarding these changes, including , the requirement related to recording calls between beneficiaries and Third-Party Marketing Organizations (TPMOs) and the requirements related to the TPMO disclaimer.  READ THE FULL RELEASE: Agent Broker Marketing FAQs_10.19.2022

Mutual of Omaha PDP: 2023 PDP Specialty Pricing Issue

Sourced from MOO broker communication from 10/17/2022:

Mutual of Omaha Rx℠ is committed to helping you find the right Prescription Drug Plan for your clients. We recently identified a pricing issue on specialty drugs on Plan Finder, which shows costs too low. Until the Plan Finder pricing files are updated, the mail order costs will show up incorrectly.

We are looking into the error and the schedule is set and will be updated on October 24, 2022. We are working with Connecture and Sunfire to see if pricing can be updated sooner.

Pricing Issue Highlights:

• This only impacts mail order pricing
• This only impacts a subset of specialty National Drug Codes (NDCS)
• Plan Finder pricing will be updated on October 24, 2022

Clients who purchase a Mutual of Omaha Rx plan, while the pricing is incorrect will receive notification from us.

CMS’s 2023 5 Star Rating Carriers & Plans for Ohio

Sourced from Aultcare broker email communication on 10/12/22:

We are pleased to announce the Centers for Medicare and Medicaid Services (CMS) awarded PrimeTime Health Plan with a 5 out of 5 star rating for 2023!

This is the second year in a row PrimeTime Health Plan has received the 5-star recognition!

This top rating is a result of PrimeTime Health Plan’s dedication to quality of care and quality of service.

We are excited that a 5-star rating allows our organization to market our plan year-round, which means you can sell our plans throughout the 2023 year.

Additionally, a 5-star rated allows us to enhance plan benefits and programs for our members. These enhancements improve our members’ quality of life and experience with the health plan, leading to continued positive outcomes.

Throughout the rest of the year and into 2023, our representatives will continue to work with you and provide the necessary educational materials to promote PrimeTime Health Plan and its 5-star rated benefits to your clients.

Thank you for your dedication to PrimeTime Health Plan as we show our communities why PrimeTime Health Plan is one of the highest rated Medicare Advantage Plans in Ohio!


Sourced from Devoted broker email communications:

All our eligible Medicare Advantage plans earned top Stars Measure ratings

We’re thrilled to share that 100% of our members in eligible plans are on a plan that has a 4-Star rating or higher from CMS. Here’s how our plans stacked up this year:

  • Ohio: 5 out of 5 Stars
  • Florida: 4.5 out of 5 Stars
  • Texas: 4.5 out of 5 Stars
  • Arizona: 4 out of 5 Stars

Our Stars Measure ratings show what Devoted Health is doing is different

We’re committing to providing the best quality care for older Americans through our all-in-one healthcare solution. Our results reflect the exceptional caliber of service and care made possible by our integrated solution and the dedication of our team. Read more about our results.

Ohio HMO plans earned 5 out of 5 Stars

This is a huge feat — and another reason to feel good about selling Devoted Health to your clients.

Very few Medicare Advantage plans earn a 5-Star rating. Only about 11% of the Medicare plans reviewed this year earned that rating. Only 1 other plan earned a 5-Star rating in their first year! 

Other big wins across all our markets:

  • 5 out of 5 Stars rating on customer service
  • 5 out of 5 Stars overall rating of health plan

You can read more about Devoted ratings on Feel free to let your clients know all about our Star ratings.


Sourced from MMO’s Press Release on 10/7/22:

CLEVELAND, Ohio — Medical Mutual’s Medicare Advantage preferred provider organization (PPO) and health maintenance organization (HMO) plans both achieved the Centers for Medicare and Medicaid Services’ (CMS) top rating, 5 out of 5 Stars, for 2023.

This is the second consecutive year in which the Company achieved 5 Stars for its PPO plans. In addition, Medical Mutual elevated the rating of its HMO plans from 4.5 Stars in 2022.

CMS rates plans from 1 to 5 Stars, with 5 representing excellent performance. Insurers are evaluated on what they do to keep members healthy, including preventive screenings and vaccines; how well they help members manage chronic conditions like heart disease and diabetes; how responsive the plan is to making sure members get the care they need; how they help resolve member complaints; and customer service.

The 5-Star rating allows individuals to switch to a Medical Mutual Medicare Advantage plan anytime throughout the year. Lower-rated plans can only accept enrollment during the Medicare Annual Enrollment Period, which runs Oct. 15 through Dec. 7.

In addition, because Medical Mutual’s Medicare Advantage plans come with a Medicare Part D Prescription Drug Plan, we also were evaluated on our members’ overall satisfaction with the drug plan, drug pricing and patient safety.

“Medical Mutual is committed to keeping our members healthy through preventive care and management of chronic conditions. These exceptional ratings reflect that commitment,” said Dr. Tere Koenig, Medical Mutual Executive Vice President and Chief Medical Officer. “We also make member experience a priority. We always strive to provide outstanding customer service.”

“In my short time here at Medical Mutual, I’ve seen how dedicated our team members are to providing the highest quality of care and services to our members,” said President and CEO Steve Glass. “That dedication and genuine consideration allow us to provide an exceptional member experience. We will continue to strive to maintain these high standards.”

Medical Mutual entered the Medicare Advantage market in 2016, earning the highest enrollment of any new plan that year.

About Medical Mutual of Ohio

Founded in 1934, Medical Mutual is the oldest and one of the largest health insurance companies based in Ohio. We provide peace of mind to more than 1.2 million Ohioans through our high-quality health, life, disability, dental, vision and indemnity plans. We offer fully insured and self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement and individual plans. Medical Mutual’s status as a mutual company means we are owned by our members, not stockholders, so we don’t answer to Wall Street analysts or pay dividends to investors. Instead, we focus on developing products and services that allow us to better serve our customers and the communities around us and help our members achieve their best possible health and quality of life. For more information, visit the company’s website at

# # #

MedMutual Advantage plans are HMO and PPO plans offered by Medical Mutual of Ohio with a Medicare contract. Enrollment in a MedMutual Advantage plan depends on contract renewal. Every year, Medicare evaluates plans based on a 5-Star rating system.

Sourced from UHC broker email communication from 10/14/22:

Star Ratings – First, a reminder: You still have access to our 2022 5-Star plans for enrollments effective Nov 1st and Dec 1st. Anyone who has a Medicare card and lives in the 5 Star Plan’s service area is eligible to enroll into a 5 Star plan if they haven’t already used the 5 Star SEP with us this year.


2023 Star Ratings were released by CMS late last week and UnitedHealthcare will continue to have more people in 4-star plans or higher than any other carrier in the industry. Approximately 81% of our Medicare Advantage members around the country are in 4-star plans or higher for 2023 Star Year Ratings. Additionally, approximately 94% of UnitedHealthcare Dual Special Needs Plan (DSNP) national membership will be in plans rated 4-stars or higher.

In Ohio, UnitedHealthcare is proud to offer plans with 4 Stars, 4.5 Stars and even 5 Stars with the plan specific detail as follows:


Contract H Number                # Stars                      Plan Names

CMS Contract # H0271            4 STARS                     Full Dual SNP Choice (our statewide PPO for Full Dual Medicare-Medicaid status)

CMS Contract # H8768            4 STARS                     AARP Medicare Advantage Choice Plan 4 PPO, Choice Flex PPO, Choice PPO, Patriot PPO

CMS Contract # H5253            4.5 STARS                 AARP Medicare Advantage Plans 5, 6, 2, 3 and Full Dual SNP -059, Partial Dual SNP Select -122

CMS Contract # H5322          5 STARS                    Full Dual SNP -028 and Partial Dual SNP Select -034


Sourced from Summacare broker communication from 10/9/22:

Summacare is honored and incredibly proud to have received 5 STARSMedicare’s highest rating for SummaCare Medicare Advantage plans for 2023 in Ohio.

SummaCare has been providing high-quality, cost-effective coverage to our Medicare members for over 25 years. This highest-star rating from CMS underscores the commitment and tremendous dedication that their entire SummaCare team and the incredible network healthcare providers all have to improving the health, well-being and member experience for our members.

This is quite an accomplishment for the entire organization and reflects Summacare’s focus and commitment to delivering the highest-quality service and member experience possible.

This rating demonstrates their commitment to being the trusted and preferred navigator to high quality healthcare that improves the quality of life for members and the communities they serve. As a result of the 5-STAR rating, SummaCare will be able to enroll eligible seniors throughout most of the 2023 calendar year—not just limited to the AEP period.

SummaCare is an HMO and HMO-POS plan with a Medicare contract. Enrollment in SummaCare depends on upon contract renewal. Every year, Medicare evaluates plans based on a 5-Star rating system.

Quote and Compare Cigna plans in MedicareCENTER

If you’re newly appointed with CignaHealthspring and working in MedicareCENTER to quote and compare carrier plans and products, this is news for you!


Cigna activates your appointment once your first application is submitted.  This means Cigna products will not initially appear in MedicareCENTER if you have not yet written an application. This affects your ability to quote and compare Cigna products.  To launch Cigna in MedicareCENTER in order to quote and compare, access and enable Cigna from the non-licensed plans option.


NOTE:  Active, licensed status to quote and ENROLL Cigna products from MedicareCENTER will be available upon submission of your first enrollment, which must be submitted to Cigna either via paper app or from the Cigna portal.


Questions about Cigna?  We can help – give us a call at 614-763-2255

Cigna Pharmacy Update: An update on Kroger and its affiliated pharmacies

Sourced from Cigna Broker Communication from 10/14/22:

Kroger and its affiliated pharmacies recently notified Cigna that they would not participate in Cigna’s Medicare Advantage (MAPD) and Prescription Drug Plan (PDP) network, effective January 1, 2023. Please note, 2022 is not impacted.

We understand that the annual enrollment period (AEP) begins tomorrow and the timing of this announcement is less than ideal. However, we were only recently notified of the contract change with Kroger for 2023 and we felt it was important to share this information with you and your brokers regardless of the pre-AEP timing. We’ve sent communications to brokers licensed within each impacted market that includes the name(s) of the Kroger pharmacy or affiliate impacted by this change. Attached is a complete list of Kroger Pharmacy Affiliates for your reference.

As you can imagine, our AEP materials were prepared well in advance. We are diligently working to update the CMS Plan Finder, sales kits, Cigna’s online provider directory, and other online tools. In fact, updates to the online tools will be made by October 24.

We are doing everything we can to make this transition as smooth as possible for our customers. While we understand the disruption, Cigna Medicare has more than 63,000 network pharmacies available nationwide, which are listed in our online provider directory. Here are a few other large pharmacy chains that continue to be available to our customers:
• Walgreens
• Walmart
• Publix
• Rite Aid
• Winn-Dixie

Mail order is also available, delivering prescriptions right to customers’ mailboxes.

To provide you some insight into our member outreach strategy, beginning November 1, we will notify customers who have used a Kroger pharmacy in the past six months that Kroger and its affiliated pharmacies are terminating. In addition to the letter, we will actively engage customers through proactive, outbound calls to help them find an in-network pharmacy nearby. Our customer service team is also prepared to offer customers convenient alternative pharmacies for them to use


VIEW THE Affiliated pharmacies owned and operated by Kroger HERE