Agencies Clarify that Medicare Advantage Plans Not Subject to Employer SBC Requirements

August 8, 2012


The Department of Labor on August 7 released an additional Frequently Asked Question confirming that employers that offer Medicare Advantage plans as part of their group health plan benefits are not required to provide a summary of benefits and coverage (SBC) for such plans.  The FAQ was prepared jointly by DOL, Health and Human Services, and Treasury.

The agencies noted that Medicare Advantage benefits are the equivalent to Medicare A and B benefits, which are set by Congress and regulated by the Centers for Medicare & Medicaid Services.  The FAQ added that, pending further guidance, the Departments will not take any enforcement action against a group health plan because it does not provide an SBC with respect to a Medicare Advantage benefit package.  

In addition, the FAQ said that this enforcement policy does not affect other disclosure requirements administered by CMS that apply to Medicare Advantage organizations, nor does the policy affect the obligation of group health plans that offer Medicare Advantage benefit options to ensure that SBCs are provided with respect to other benefit packages they offer.

Contact Gretchen Young ( with any questions or comments on this issue.

Additional FAQ on SBC Requirements