Coverage Summaries and Policy Guidelines for Medicare Advantage Members
Hierarchy of References / Resources
We develop our MA Coverage Summaries and Policy Guidelines with the help of:
- National Coverage Determination (NCD) or other Medicare guidance, e.g., Medicare Policy Benefit Guide, Medicare Managed Care Guide, Medicare Claims Processing Guide, Medicare Learning Network (MLN) Matters Articles
- Local Coverage Determination (LCD) and Local Policy Articles (A/B MAC & DME MAC)
- UnitedHealthcare Commercial Medical Policies/Coverage Determination Guidelines
Coverage Summaries and Policy Guidelines
Our MA plan Evidence of Coverage (EOC) and Summary of Benefits (SB) list the member’s covered benefits, limitations and exclusions. We use our MA Coverage Summaries and Policy Guidelines to interpret benefits for our members. The policies are subject to change based on Medicare’s coverage requirements, clinical evidence, technology and evolving practice patterns. You are responsible for reviewing the CMS Medicare coverage guidance documents. If there is a conflict between our policies and the guidance documents, the CMS information controls.
Our MA Coverage Summaries and Policy Guidelines are available on our Medicare Advantage Policies page.
Coverage Summary and Policy Guideline Updates
We publish monthly editions of the Medicare Advantage Coverage Summary and Policy Guideline Update Bulletins. These online resources provide notice to our network care providers of changes to MA Coverage Summaries and Policy Guidelines.
The bulletins are posted on the first calendar day of every month on:
- Medicare Advantage Coverage Summary Update Bulletins
- Medicare Advantage Policy Guideline Update Bulletins
A supplemental reminder to the detailed policy update summaries announced in the Medicare Advantage Coverage Summary and Policy Guideline Update Bulletins is also included in the monthly Network Bulletin.