Medicare Managed Care Manual (Pub. 100-16), Ch. 4 § 10.6
Multiple Plan Offerings and Benefit Caps
10.6- Multiple Plan Offerings and Benefit Caps
(Rev. 121, Issued: 04-22-16, Effective: 04-22-16, Implementation: 04-22-16)
An MAO may offer more than one MA plan in the same service area (though each plan is
subject to the conditions and limitations established for the MA program). Caps for a
supplemental benefit can only be imposed at the MA plan level. For example, during a
contract year, if an enrollee switches to another MA plan offered by the same MAO in
the same service area, then an enrollee who has exhausted the supplemental benefit of
one plan is entitled to the full benefit of the other plan. This does not preclude MAOs
from providing benefits with periodic caps such as monthly or quarterly caps, so long as
general benefit standards, such as actuarial equivalence for basic benefits and compliance
with anti-discrimination provisions, are met.