Cost-sharing for In Network Preventive Services

50.2 – Cost-sharing for In Network Preventive Services (Rev. 121, Issued: 04-22-16, Effective: 04-22-16, Implementation: 04-22-16) MA plans are required to cover without cost-sharing all in-network Medicare-covered preventive services for which there is no cost-sharing under original Medicare (42 CFR §422.100(k)). Plans are responsible for monitoring CMS’ National Coverage Determinations and publications in order to ensure they are offering, in a timely manner, all Medicare Part A and Part B services, including the zero cost-sharing preventive services. MA plans may not charge for facility fees, professional services, or physician office visits if the only service(s) provided during the visit is a preventive service that is covered at zero cost-sharing under original Medicare. However, if during provision of the preventive service, additional non-preventive services are furnished, then the plan’s cost-sharing standards apply. Enrollees of a plan may directly access (through self-referral to any plan participating provider) in-network screening mammography and influenza vaccine. Please see section 90 of this chapter for information on National Coverage Determinations (NCDs) which describes the requirements for plan compliance with new NCDs, as well as website resources for monitoring NCDs.