FAQ on CMS Regulations for Rewards & Incentives in Medicare Advantage

Member incentives are a critical lever that health plans have to improve member engagement and gap closure, pushing plans closer to their performance goals. With Healthmine, rewards increase gap closure rates by 93% on average across client programs.

But incentive programs come with strict guidelines set by the Centers for Medicare & Medicaid Services (CMS). Violation of these guidelines could result in fines or other penalties. Because Healthmine has administered many rewards programs, we know a thing or two about how to structure them to ensure compliance and effectiveness. We compiled a list of frequently asked questions (FAQs) we commonly hear when talking with new Medicare Advantage (MA) plan partners about implementing an incentives program.

FAQs include:

• What can and cannot be included in a rewards program
• What CMS considers a "qualifying individual" and the nuances in which rewards must be available to all enrolled members versus a subset of the population
• Real-world examples for applying incentives to specific care gaps
• What health plans must avoid in their rewards programs to maintain CMS compliance

We encourage all MA plans to download the FAQ and reach out to us to learn more about how to administer a more cost-effective and high-performing rewards program.