Template Comments & Instructions: Medicare Part C & Part D Rule  – Justice in Aging

Jump to the template letter.

Instructions 

The Centers for Medicare & Medicaid Services (CMS) has released a proposed rule to make changes to Medicare Advantage (Part C) and Prescription Drug Plans (Part D) plans. Your comments are needed to create a strong record and ensure that your support or concerns are heard. Justice in Aging has created template comments to guide you.

This document provides a Glossary below of terms and acronyms. For each area for commenting, we have provided a summary of the proposal and examples of what would be helpful to include in your comments.

Please:  

• Address as few or as many areas as you wish. Even one or two examples showing the impact of one of the proposed changes would help. Organizations that have the bandwidth to go deeper—please do!    
• If you have client stories or personal experiences with the proposal that support your comments, please make sure to include them!  Please make sure to leave out details that could identify the person.  
• CMS values comments that are unique. Please feel free to write the comment in your own words.  
• Page numbers refer to the PDF page number.   

Comment Deadline: January 26, 2026, at 5 pm Eastern / 2 pm Pacific. Note that the timing of the deadline is earlier in the day than usual. Submit comments here. 

Glossary 

Dual Eligible Special Needs Plan (D-SNP): D-SNPs are a subset of Medicare Advantage plans that specifically serve individuals dually enrolled in Medicare and Medicaid. D-SNPs are subject to federal oversight and must comply with Medicare Advantage regulations and guidance. Each D-SNP sponsor must enter into a contract with the state Medicaid agency in which the D-SNP operates. The extent to which D-SNPs coordinate with Medicaid varies. Coordination Only, Highly Integrated, Fully Integrated, and Applicable Integrated plans are all types of D-SNPs with different integration and coordination requirements. Read more in Dual Eligible Special Needs Plans (D-SNPs): What Advocates Need to Know.  

Special Supplemental Benefits for the Chronically Ill (SSBCI): Items and services that have a reasonable expectation of improving or maintaining the health or overall function of the chronically ill enrollee. SSBCI benefits are developed by Medicare Advantage plans and provided to individuals who have a complex chronic illness, have a high risk of hospitalization or other adverse health outcomes, and require intensive care coordination.  

State Medicaid Agency Contract (SMACs): Contracts, developed by a state, that a D-SNP must agree to in order to operate in the state. According to federal rules, SMACs must include the same Medicare and Medicaid services a D-SNP must cover, the same cost-sharing a D-SNP must cover, and who is eligible to enroll in a D-SNP.  

Template

Download as Word (.docx)

January 26, 2026

Centers for Medicare & Medicaid Services
Department of Health and Human Services
Attention: CMS–4212– P
P.O. Box 8013, Baltimore, MD 21244– 8013.

Submitted electronically via regulations.gov

Re: Medicare Program; Contract Year 2027 Policy and Technical Changes to the Medicare Advantage Program, Medicare Prescription Drug Benefit Program (CMS 4212-P)

[Organization] appreciates the opportunity to provide comments on the above-referenced Notice of Proposed Rule Making. [Describe your organization briefly].

[Organization] has many concerns about the proposals in the above-referenced Notice of Proposed Rulemaking. These comments specifically address elements of those proposals affecting individuals dually eligible for Medicare and Medicaid, including older adults and persons with disabilities and the impact the changes would have on the individuals that our organization serves.

1. Decreasing Awareness of the State Health Insurance Assistance Program (SHIP)

Summary: In section IV.E on page 57 (entitled, “Updating Third-Party Marketing Organizations Disclaimer Requirements”), CMS proposes removing a language describing the SHIP in standard language that marketing organizations are required to use when speaking with potential enrollees. Potential enrollees are still directed to 1-800 MEDICARE and Medicare.gov. In explaining this proposal, CMS indicates a strong preference against referring to SHIPs, indicating that counselors may not have the expertise to help enrollees navigate complex program issues.

Helpful areas to comment:

• Opposition to the proposed change. Support for the SHIP program, including examples of when SHIP counselors have helped solve Medicare and Medicaid issues.
• Support for increasing awareness of the SHIP program, including examples of when a Medicare enrollee had higher barriers to care because they found out about SHIP too late.
• Information about the high level of expertise that SHIP programs offer, including examples of times when Medicare enrollees could not get issues fixed through 1-800 MEDICARE or Medicare.gov, but their SHIP counselor provided valuable assistance.

2. Limiting Protections Against Pressure to Enroll in a Medicare Advantage Plan

Summary: CMS is relaxing requirements designed to protect Medicare enrollees from pressure to enroll in Medicare plans. Specifically:

• In Section VI.F on page 58 (entitled “Removing Rules on time and Manner of Beneficiary Outreach”), CMS proposes allowing marketing events to occur after educational events in the same location.
• In Section IV.H on page 64 (entitled “Third-Party Marketing Organization Oversight: Revising the Record Retention Requirements for Marketing and Sales Call Recordings”), CMS proposes shortening the time an organization must retain audio records of calls. CMS’s proposed regulation also deletes requirements in 42 C.F.R. 422.2274(g)(2)(ii) and 423.2274(g)(2)(ii) to keep audio recordings of enrollment calls.

CMS notes that dually eligible individuals and others who may be susceptible to pressuring tactics often come to events with a caregiver, which provides an additional layer of protection. CMS also notes that there is a Special Enrollment Period for individuals who were given misleading statements.

Helpful areas to comment:

• Opposition to the proposed change. Support for current rules that separate educational activities from sales activities to help a Medicare enrollee make the best choice for themselves with limited pressure to enroll.
• Examples of when individuals were pressured into enrolling into Medicare Advantage plans. Some examples could include times when individuals were not given accurate information about how Medicare Advantage enrollments can jeopardize their retiree coverage and dually eligible individuals who are sold benefits already available to them through Medicaid.
• Stories of how difficult it is to access the Special Enrollment Period for individuals who were given misleading statements when enrolling in a Medicare Advantage plan, and the barriers to care that enrollees face when trying to change plans after misleading sales tactics occur.

3. Relaxing Prohibitions on Misleading, Inaccurate, and Superlative Advertising

Summary: In Section IV.G on page 63 (“Relaxing the Restrictions on Language in Advertising”), CMS proposes relaxation of marketing requirements, including deletion of a regulatory prohibition on giving inaccurate information, misleading information, and superlatives.

Helpful areas to comment:

• Opposition to the proposed change. Support for keeping marketing requirements that do not allow inaccurate information, misleading information, and superlatives. Individuals who enroll as a result of these practices can have issues accessing services and providers.
• Examples of when individuals enrolled in a Medicare Advantage plan based on misleading advertising, and any negative impacts that they experienced as a result.
• Examples may include times when enrollees are surprised by the limitations of supplemental benefits and provider networks despite the advertisements touting those benefits and networks.

4. Language and Communication Access: Notices and Star Ratings Measures

Summary: Individuals are entitled to free interpreter services and auxiliary aides when working with Medicare Advantage plans and prescription drug plans. Regulations require Medicare Advantage plans and prescription drug plans to provide a “notice of availability” alerting individuals to their rights to free interpretation services. In Section IV.I on page 66 (“Rescinding the Requirement for the Notice of Availability”), CMS proposes deleting the Medicare regulations that specify how Medicare Advantage plans and prescription drug plans must provide a notice of availability. While all plans will still be required to provide a notice of availability under Section 1557 nondiscrimination regulations (45 C.F.R. 92.11(a)), those requirements enforced by the Office for Civil Rights are not as tailored to Medicare and do not require plans to provide the notice in languages beyond the top 15 if they are the primary language of at least 5% of the individuals in the plan service area. As a result, some Medicare enrollees may not receive notices of language access services in their language and plans may try to provide the notice in fewer instances.

In Section V on page 71 (“Star Ratings”), CMS also proposes removing quality metrics measuring whether Medicare Advantage Plans are providing access to foreign language interpreters and Deaf communication access (via TTY). CMS states the reasoning behind this change is that plans have very high performance on these metrics and there is little variation across plans.

Helpful areas to comment:

• Opposition to the proposed recission. Support for keeping the requirement for plans to provide a Notice of Availability in all the required documents and languages specified in the Medicare regulation (at 422.2267(e)(31) and 423.2267(e)(33)), as it gives Medicare enrollees clear notice that access to interpretation is free.
• Support for quality metrics that measure whether individuals are provided with required language interpretation and Deaf communication access. This is a core component of quality and CMS should consider alternatives to scoring these measures before removing them completely.
• Examples of when individuals had barriers to care due to lack of access to interpretation or other communication access issues with the Medicare Advantage plan or Prescription Drug Plan. Examples of how the Notice of Availability helped individuals get language assistance services or auxiliary aides, and how that assistance empowers individuals to manage their health coverage and reduces burden on your organization or other community-based organizations with limited resources.

5. Care Coordination for Individuals Enrolled in a D-SNP and Medicaid Fee for Service

Summary: In Section VI.C on page 79 (“Continuity in Enrollment for Full-Benefit Dually Eligible Individuals in a D-SNP and Medicaid Fee-for-Service”), CMS proposes requiring some D-SNPs to engage in additional care coordination activities and report those activities to CMS. This effort would likely bolster activities to improve the experience of dually eligible individuals who are in Medicaid fee for service and enrolled in a D-SNP.

Helpful areas to comment:

• Support for improving the experience of dually eligible individuals enrolled in D-SNPs by ensuring that D-SNPs are providing care coordination to everyone, including individuals who are in Medicaid fee-for-service (rather than enrolled in a Medicaid managed care plan). D-SNPs should be ensuring that all dually eligible enrollees experience high-quality integration, meaning:
  • Members can access their Medicare and Medicaid benefits without delay;
  • Members have access to quality, person-centered care coordination;
  • Integrated service plans encompass services beyond those typically covered by Medicare and Medicaid; and
  • Integrated plans advance rebalancing efforts through nursing facility diversion and transition programs.
• Examples of dually eligible individuals in Medicaid fee-for-service who would benefit from D-SNP assistance with care coordination (including assistance accessing Medicaid services, filing Medicaid appeals, accessing transportation, and navigating transitions of care from hospital to home and nursing facility to home).

6. Improving State Oversight of D-SNPs

Summary: States are a key partner in monitoring D-SNP activities and acting to improve enrollee access to care. CMS is proposing two changes that would improve a state’s ability to engage in D-SNP oversight:

• In Section VI.D on page 83 (“Contract Modifications for DSNPs Following State Medicaid Agency Contract Termination”), CMS proposes to codify a pathway for terminating a D-SNP contract that is not in compliance with state requirements.
• In Section VI.E on page 84 (“Limitations on D-SNP-Only Contracts Submitting Materials under the Multi-Contract Entity Process”), CMS proposes to require D-SNPs and other entities to submit materials to a CMS portal in a manner that allows states to review those materials.

Helpful areas to comment:

• Strong support for these proposed enhancements that allow states to monitor the activities of D-SNPs and take action if D-SNPs are not providing adequate access to care.
• Examples of where your state has been helpful in the oversight of marketing, enrollee access to care, and other issues.

7. Request for Information: Concern About C-SNPs and I-SNPs

Summary: In Section VI.F on page 85 (“C-SNP and I-SNP Growth and Dually Eligible Individuals”), CMS describes a concerning trend where dually eligible individuals appear to be enrolling in chronic illness special needs plans (C-SNPs) and institutional special needs plans (I-SNPs). Since C-SNPs and I-SNPs do not have the same care coordination requirements that D-SNPs do, CMS expressed concern that these enrollees may not be receiving well-integrated care. In a Request for Information, CMS asked for more information.

In the past, CMS has used “D-SNP lookalike rules” to prevent Medicare Advantage plans from enrolling a high number of dually eligible individuals without being subject to heightened integration requirements. D-SNP lookalike rules do not apply to C-SNPs or I-SNPs. CMS is considering restricting the number of dually eligible individuals enrolled in a C-SNP or I-SNP by expanding “look-alike” rules to apply to I-SNPs and C-SNPs. For more information on D-SNP look-alike rules, see page 7 of the Justice in Aging D-SNP basics brief.

CMS is also considering adding more dually enrolled care coordination requirements for I-SNPs and C-SNPs that have a lot of dually enrolled enrollees.

Helpful areas to comment:

• Support for a system where a dually eligible individual who is enrolled in a C-SNP or I-SNP can access high-quality integration, including accessing their Medicaid and Medicare benefits without delay, and have access to quality person-centered care coordination. This can be accomplished through heightened requirements for I-SNPs and C-SNPs to engage in care coordination and integration. Alternatively, if C-SNPs and I-SNPs are not providing adequate coordination and integration, support for caps on the number of dually eligible individuals allowed to enroll in C-SNPs and I-SNPs through an expansion of D-SNP look-alike rules.
• Stories from dually eligible individuals enrolled in C-SNPs and I-SNPs, including barriers to accessing care.
• Any examples of a dually eligible individual enrolled in a C-SNP or I-SNP under questionable circumstances (e.g. pressure to enroll, misleading information, enrolling a person without their knowledge, or enrolling a person without their consent).

8. Removing Notice to Enrollees about Available Supplemental Benefits

Summary: Medicare Advantage plans offer many types of supplemental benefits, but there are indications that enrollees don’t always know about these benefits or use them. Starting next year, Medicare Advantage plans were going to be required to send a notice to enrollees letting them know about supplemental benefits that they are eligible for and haven’t used yet. In Section VII.C on page 94 (“Rescind Mid-Year Supplemental Benefits Notice”), CMS proposes to no longer require such a notice.

Helpful areas to comment:

• Opposition to the proposed change. Support for implementing the mid-year notice of unused supplemental benefits notice, since that notice will alert individuals to benefits that they can access.
• Examples of times when individuals did not understand what supplemental benefits they could be eligible for.

9. Stopping Public Reports on Prior Authorization

Summary: Individuals who enroll in Medicare Advantage experience high rates of prior authorization, which can delay care. In July 2025, Medicare Advantage plans were going to be required to publish an analysis of their prior authorization activities, including data on how prior authorization affected people with disabilities and other demographic groups. In June 2025, CMS paused the release of these reports. In Section VIII.E on page 95 (“Rescinding the Annual Health Equity Analysis of Utilization Management Policies and Procedures”), CMS proposes no longer requiring these reports.

Helpful areas to comment:

• Opposition to the proposed change. Support for keeping the requirement to release prior authorization reports, including analyses of impacts of prior authorization on different communities.
• Examples of how prior authorization has harmed access to care for individuals, and how hard it is to see a plan’s track record with prior authorization practices.

10. Access to Services and Quality Improvement

Summary: Medicare Advantage plans are required to offer access to services, including access for (1) people of ethnic, cultural, racial, or religious minorities; (2) people with disabilities; (3) members of the LGBTQI community; (4) individuals in rural areas and areas with high levels of deprivation; (5) people affected by persistent poverty or inequality; and (6) People with limited English proficiency or reading skills. In Section VII.D on page 95 (“Revisions to Ensuring Equitable Access to Medicare Advantage Services”), CMS proposes deleting references to the above listed groups numbered (1) through (5) when describing a Medicare Advantage plan’s obligation to provide access to services. The proposed regulation would read, “Cultural considerations. Ensure that services are provided in a culturally competent manner to all enrollees, including those with limited English proficiency or reading skills, and diverse cultural and ethnic backgrounds.”

Additionally, Medicare Advantage plans are required to engage in quality improvement programs. They are currently required to include activities to reduce disparities in health and health care. In Section VII.F at page 97 (“Rescinding the Quality Improvement Program Health Disparities Requirement”), CMS proposes deleting the requirement to include activities to reduce disparities as part of Medicare Advantage quality improvement programs.

Helpful areas to comment:

• Opposition to the proposed changes. Support for keeping in place in-care access regulations and references to specific groups that have historically experienced discrimination in accessing Medicare services.
• Support for keeping in place requirements for quality improvement activities to include the reduction of disparities.
• Stories of how anti-discrimination rules and quality improvement can protect access to care for individuals.

11. Request for Information: Medicare Advantage Plans

Summary: CMS is seeking information under a broad Medicare Advantage Request for Information on how to make Medicare Advantage plans better. Topics include access to interpretation and translation; requirements around marketing, agents, and brokers; adequacy of provider networks; models of care for special needs plans; risk adjustment; quality improvement; and access to nutrition and well-being.

Helpful areas for comment:

• Support for improved access to high-quality integration, including safeguarding consumer choice, enabling access to unbiased decision-making, and support for improved access to care and improved experience.
• Examples when individuals experience challenges with commercials, advertising, and interactions with agents and brokers.
• Examples of how access to translations and interpreters were helpful in improving access to services.
• Examples of how individuals experience barriers to care, including challenges related to being dually eligible for Medicare and Medicaid.
• Examples of barriers to accessing services, including prior authorization and narrow provider networks.
• Examples of how Medicare coverage can help address food access, the psychosocial needs of older adults (including efforts to address isolation and loneliness), and improve health, happiness, and satisfaction in life.