How to Use Disclaimers for PFFS & MSA Plans


When creating marketing material for Medicare Private Fee-for-Service (PFFS) and Medicare Savings Account (MSA) plans, CMS requires that you include specific disclaimers (MMG, Appendix 5).

What Is the PFFS Plan Disclaimer?

PFFS materials targeting potential enrollees must include the following: A Private Fee-for-Service plan is not Medicare supplement insurance. Providers who do not contract with our plan are not required to see you except in an emergency.

What Are the MSA Plan Disclaimers?

Medicare Savings Account (MSA) marketing material must include the following three disclaimers:

  1. MSA plans combine a high deductible Medicare Advantage plan and a trust or custodial savings account (as defined and/or approved by the IRS). The plan deposits money from Medicare into the account. You can use this money to pay for your healthcare costs, but only Medicare-covered expenses count toward your deductible. The amount deposited is usually less than your deductible amount, so you generally have to pay out-of-pocket before your coverage begins.
  2. Medicare MSA plans don’t cover prescription drugs. If you join a Medicare MSA plan, you can also join any separate Medicare Prescription Drug Plan.
  3. There are additional restrictions to join an MSA plan, and enrollment is generally for a full calendar year unless you meet certain exceptions. Those who disenroll during the calendar year will owe a portion of the account deposit back to the plan. Contact the plan at [insert customer service and TTY] for additional information.

Where Can I Get More Medicare Marketing Guidance?

Our resource center is available 24/7 to give you the help you need with Medicare guidelines, sales advice, and more to keep your business on track. To learn more about the Excelsior team and how we can help you, contact us.

 

Source:https://www.cms.gov/Medicare/Health-Plans/ManagedCareMarketing/Downloads/CY-2018-Medicare-Marketing-Guidelines_Final072017.pdf

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