Beneficiary Rights: The Part C & D Rules That Govern Patient Communications (42 CFR § 422.110)

Beneficiary rights under Medicare Advantage (Part C) and Part D are not just abstract legal protections. They directly shape what your staff may say, how they say it, and what they must never omit when communicating with patients. At the core is 42 CFR 422.110, which prohibits discrimination by MA organizations based on health status–related factors, ensuring that communications and access to services are fair, consistent, and not slanted toward “good risks” only.

Those protections are reinforced by disclosure rules at 42 CFR 422.111 for Part C and 42 CFR 423.128 for Part D, which require clear, accurate, standardized information about benefits, costs, and rights, and by communications and marketing standards at 42 CFR 422.2260 and 423.2260. Together, they create a framework where small practices must treat every conversation, reminder call, or “quick question” as a regulated touchpoint.

For a lean clinic, the risk is simple: an untrained front-desk or billing staff member promises the “cheapest plan,” discourages a high-need patient from switching providers, or fails to give complete information. Those patient communications can be viewed by CMS and contracted plans as discriminatory or misleading, and they become evidence in beneficiary complaints, program audits, or enforcement actions.

By building a minimal but disciplined structure around scripts, notices, documentation, and staff training, your practice can protect beneficiaries, reduce complaints, and avoid being pulled into a Part C or D compliance investigation.

Small practices rarely think of themselves as part of “Medicare Advantage compliance,” yet if you treat MA or Part D patients, your staff are on the front line of beneficiary rights. The regulations do not expect physicians or clinics to behave like insurance brokers, but they do expect you not to discriminate, not to mislead, and not to steer patients based on financial or risk considerations. 42 CFR 422.110 sets the nondiscrimination baseline for MA organizations, and in practice, contracted providers are expected to support that baseline when they interact with enrollees.

At the same time, 42 CFR 422.111 and the parallel Part D provisions at 42 CFR 423.128 require clear and accurate disclosures of key plan information, which shapes what materials plans must make available and what they often require contracted providers to help distribute or explain. Add in the communications and marketing rules at 42 CFR 422.2260 and 423.2260, and suddenly a casual comment about “which plan is better” can cross into regulated territory.

For small practices, this means you need just enough structure so that every person who answers the phone or talks with patients understands three core concepts: do not discriminate, do not mislead, and know when to refer beneficiaries back to their plan or to official resources instead of giving plan recommendations.

Understanding Legal Framework & Scope Under 42 CFR 422.110

42 CFR 422.110 requires that MA organizations “not discriminate based on health status–related factors” in beneficiary enrollment, disenrollment, or access to services, including conditions such as illness, disability, medical history, or claims experience. While the section is written for MA organizations, the practical reality is that contracted providers are part of what CMS evaluates when it reviews whether beneficiaries are being treated fairly. If your communications appear to discourage sicker patients, or preferentially support low-risk enrollees, that can surface as a nondiscrimination concern.

The broader framework includes:

• 42 CFR 422.111: MA organizations must disclose benefits, costs, rules, and grievance/appeal rights in a clear, accurate, and standardized format at enrollment and annually.

• 42 CFR 423.128: Part D sponsors must provide standardized benefit and formulary information for prescription coverage, again in a clear, accurate fashion.

• 42 CFR 422.2260 and 423.2260: Define “communications” and “marketing,” including what providers and plans may and may not do when interacting with beneficiaries about plan options.

Federally, this framework is mandatory for Medicare Advantage and Part D programs. States may add extra consumer protection rules (for example, insurance department marketing requirements), but they cannot lower the federal floor. In practice, your contracts with MA and Part D plans incorporate these federal standards and sometimes add plan-specific limits on what you may say or distribute.

Understanding this framework reduces denials, penalties, and administrative friction because it helps you channel patient questions correctly. When staff know what rights exist, which notices apply, and when to redirect plan-selection discussions back to the plan, your clinic is less likely to generate complaints, confuse patients, or be cited in CMS audit findings.

CMS is the primary enforcement body for Medicare Advantage and Part D requirements, including beneficiary rights and communications. Through its audit program, program oversight, and complaint tracking, CMS evaluates how plans and their first tier, downstream, and related entities (FDRs) handle beneficiary interactions.

Key enforcement and oversight mechanisms include:

• Beneficiary complaints filed with 1-800-MEDICARE or directly with plans, which are tracked and trended at CMS. Communications that appear discriminatory or misleading can quickly escalate.

• Program audits of MA and Part D sponsors, where CMS reviews call logs, scripts, correspondence templates, and provider materials to assess compliance with 42 CFR 422.110, 422.111, and related provisions.

• Secret shopper activities and targeted reviews of marketing and communications to ensure beneficiaries receive accurate, balanced information.

• Referrals to the HHS Office of Inspector General or state agencies when fraud, waste, abuse, or systematic steering is suspected.

While CMS typically enforces directly against MA and Part D sponsors, those sponsors, in turn, enforce against their contracted providers. Poor beneficiary communications in your office can trigger corrective action plans, termination, or enhanced monitoring under your plan contracts, even if CMS never calls you directly.

Although this heading references HIPAA, the real goal here is survival in a CMS and plan audit environment when beneficiary communications are under scrutiny. The following controls are tailored to 42 CFR 422.110 and related Part C and D communication rules, and they are designed for lean clinics with limited budgets.

1. Beneficiary Communication Map

• How to implement: Build a simple spreadsheet listing each standard patient-facing communication that touches Medicare Advantage or Part D beneficiaries: appointment reminders mentioning plan rules, referral instructions, financial counseling scripts, and any printed notices. For each row, note the purpose, the typical audience, and the associated plan or legal requirement (for example, plan-supplied materials, nondiscrimination under 42 CFR 422.110, or disclosure supports under 42 CFR 422.111/423.128).

• Evidence to retain: Version-controlled spreadsheet with dates of review and names of reviewers, plus saved copies of each script or template referenced.

• Low-cost method: Use a shared online spreadsheet or free office software stored in a secure shared drive; update during a single staff huddle each quarter.

2. Script and Template Approval Gate

• How to implement: Require that any script or written material mentioning specific Part C or D plans, premiums, or benefits be pre-approved by the practice’s compliance lead and, where required, by the plan itself. Label each approved script with the date, the approving person, and its legal basis (for example, “Benefits description – supported by plan EOC and 42 CFR 422.111, not marketing” or “Nondiscrimination statement – supports 42 CFR 422.110”).

• Evidence to retain: Approval emails or sign-off forms, with archived PDF versions of every script and template.

• Low-cost method: Use a shared email folder titled “Beneficiary Communications Approvals” and a simple naming convention (for example, “Script_Referral_422.111_2025-01-15”).

3. “No Steering” Quick Guide at Every Workstation

• How to implement: Create a one-page quick guide that spells out what staff may do (for example, explain that a plan is in-network, read from plan-approved materials, direct patients to 1-800-MEDICARE) and what they may not do (for example, recommend a plan because it seems “cheaper” or discourage a high-need beneficiary from switching plans). Tie this guide explicitly to nondiscrimination obligations under 42 CFR 422.110 and communications/marketing boundaries under 42 CFR 422.2260 and 423.2260.

• Evidence to retain: Dated copies of the quick guide, plus photographs or screenshots showing it posted or accessible at workstations.

• Low-cost method: Print black-and-white copies or display a PDF on shared desktops instead of laminated posters.

4. Beneficiary Complaint and Concern Log

• How to implement: Maintain a simple log tracking any patient comment that suggests confusion, feeling pressured, or difficulty accessing services because of plan communications. Include date, patient initials, staff member involved, summary of concern, and the outcome (for example, referred to plan, internal coaching, script revision). Link the log to beneficiary protections under 42 CFR 422.110 and disclosure obligations under 42 CFR 422.111/423.128.

• Evidence to retain: Log entries, follow-up emails, and any updated scripts or notices resulting from recurring themes.

• Low-cost method: A single shared spreadsheet or notebook, reviewed monthly by the compliance lead or practice manager.

5. Annual Beneficiary Communications Review

• How to implement: Once a year, line up your scripts, notices, and communication map against the latest plan materials and CMS requirements for disclosures and marketing/communications, focusing on 42 CFR 422.111, 423.128, 422.2260, and 423.2260. Confirm that you are using current plan-supplied documents and that your internal materials do not contradict them or create discriminatory effects.

• Evidence to retain: A short memo summarizing the review, with a dated checklist and any updates made.

• Low-cost method: Schedule this review alongside your annual staff training session so content updates and training align.

6. Targeted Coaching for High-Risk Roles

• How to implement: Identify the roles most likely to cross lines in beneficiary communications (front desk, billing, referral coordinators) and provide targeted coaching that uses real scripts and scenarios from your own practice. Emphasize nondiscrimination (422.110) and the difference between neutral, factual information and plan steering or marketing (422.2260, 423.2260).

• Evidence to retain: Attendance lists, signed coaching acknowledgements, and updated job aids.

• Low-cost method: Use a 30-minute lunch-and-learn format with one simple handout and role-play instead of formal classroom training.

Together, these controls make your practice more resilient in any review of beneficiary communications. They show that you understand where 42 CFR 422.110 and related rules apply, that you actively manage patient-facing content, and that you respond to complaints and confusion with real improvements.

Case Study

A small multi-specialty clinic sees a growing number of Medicare Advantage patients. The front-desk team prides itself on being “helpful,” and over time, informal scripts develop. Staff routinely tell patients, “Plan X is usually best here because most of our doctors take it,” and sometimes add, “Plan Y is more trouble; claims take longer and copays are higher.”

One fall, a high-need beneficiary with multiple chronic conditions reports to 1-800-MEDICARE that the practice “pressured” her not to switch plans because “they said my care would be worse.” At the same time, a different patient complains to his MA plan that he was “talked into” a plan that did not cover his preferred hospital. CMS trends the complaints and flags the plan for potential steering and nondiscrimination issues under 42 CFR 422.110 and the communications/marketing rules at 422.2260 and 423.2260.

During the plan’s program audit, CMS requests call recordings, scripts, and complaint logs. The plan, in turn, requests information from the clinic because multiple complaints mention practice staff. The clinic has no approved scripts, no beneficiary communications map, and no complaint log; each staff member has their own way of “helping” patients decide. CMS concludes that beneficiaries received biased, plan-specific recommendations that could disadvantage certain enrollees, particularly those with higher expected costs.

The consequences are significant. The plan receives a corrective action plan and must retrain its downstream entities. The clinic is placed on a watch list by several MA contracts and is warned that future noncompliance could lead to contract termination. Internally, the clinic faces reputational damage with patients who feel they were misled, and staff morale suffers as they scramble to change practices under pressure.

Now imagine the same scenario with the controls described earlier in place. The clinic has a “no steering” guide at every workstation, a communications map that identifies which interactions are tightly regulated, and a complaint log. When the first complaint surfaces, the compliance lead reviews scripts, corrects the language, and documents staff coaching. When the plan requests information, the clinic can produce dated scripts, proof of training, and a log showing prompt response to concerns. Instead of being viewed as part of the problem, the clinic appears as a cooperative partner helping uphold beneficiary rights under 42 CFR 422.110 and the related communications rules.

This checklist keeps your focus squarely on beneficiary rights and communications. When completed and kept current, it demonstrates a structured approach to honoring 42 CFR 422.110 and associated disclosure and communications rules.

Common Audit Pitfalls to Avoid Under 42 CFR 422.110

A few mistakes appear again and again in CMS oversight and plan audits. Understanding them helps your clinic avoid unnecessary scrutiny.

• Treating high-need MA patients differently in appointment scheduling or referrals, such as subtly discouraging complex cases from staying with the practice, can be viewed as discrimination based on health status under 42 CFR 422.110 and may trigger plan or CMS review.

• Allowing staff to recommend specific plans based on perceived ease of billing or reimbursement, rather than neutral facts, can cross communications and marketing boundaries under 42 CFR 422.2260 and 423.2260 and lead to corrective action.

• Using outdated or plan-specific written materials that do not align with current disclosures required by 42 CFR 422.111 and 423.128 can mislead beneficiaries about networks, benefits, or costs and fuel complaints.

• Failing to document how beneficiary complaints about communications are received, investigated, and resolved can leave your clinic exposed when CMS or plans look for evidence that noncompliance is being addressed.

• Ignoring communications-related requirements in MA and Part D contracts, including obligations to distribute certain notices or refer members back to the plan, can be interpreted as a failure to support beneficiary rights under 42 CFR 422.110 and broader program requirements at 42 CFR 422.503(b).

By anticipating these pitfalls and setting up simple, low-cost controls, your practice lowers the chance that routine patient conversations will be misinterpreted as discriminatory, misleading, or noncompliant under 42 CFR 422.110 and the related communication rules.

Beneficiary rights compliance cannot be the job of one person alone, even in a small practice. You need light-weight governance that embeds these concepts in daily operations.

Assign a single “beneficiary communications lead” who owns the communication map, script library, and complaint log. Give this person authority to pause the use of any script or notice that appears risky and to coordinate with plan partners when questions arise. Tie this responsibility to formal job expectations.

Establish a simple training cadence where every staff member with patient contact receives onboarding and annual refreshers on nondiscrimination (422.110), disclosures (422.111, 423.128), and the no-steering boundaries created by 422.2260 and 423.2260. Use real examples from your practice, so the rules feel concrete, not theoretical.

Finally, define two or three monitoring metrics you can realistically track, such as number of beneficiary communication complaints per quarter, percentage of scripts with documented approvals, or time from identification of a communication issue to corrective action. Reviewing these metrics quarterly in a brief leadership huddle keeps beneficiary rights visible without adding heavy bureaucracy.

Beneficiary rights under 42 CFR 422.110 and the associated disclosure and communication rules are not optional extras for Medicare Advantage and Part D providers. They shape every conversation about coverage, every script read over the phone, and every notice handed across the front desk. In a small practice, the biggest risk is often unintentional: well-meaning staff who speak loosely about “good plans” or “bad plans,” or outdated materials that no longer reflect current benefits or networks.

By building a minimal but disciplined framework around scripts, notices, complaint handling, and staff training, you can protect beneficiaries from discrimination, reduce confusion, and demonstrate to plans and CMS that your clinic is a trustworthy partner in safeguarding patient rights.

In the next 30–60 days, a small clinic can:

1. Create a Beneficiary Communication Map and identify the top ten scripts and notices used with MA and Part D patients.

2. Implement a script approval gate and post a “no steering” quick guide at all high-contact workstations.

3. Start a beneficiary communications complaint log and review it monthly with the communications lead.

4. Schedule a short training huddle to walk staff through nondiscrimination, disclosure basics, and when to refer patients back to their plans or official resources.

Recommended compliance tool: Centralized Beneficiary Communications Log and Map maintained in a shared spreadsheet with clear owners and review dates.

Advice: 

Before the next open enrollment period, pull every script and flyer your staff uses with MA or Part D patients and remove anything that is unapproved, outdated, or plan-steering.

• 42 CFR 422.110 Beneficiary rights
  

• 42 CFR 422.111 Disclosure requirements
  

• 42 CFR 423.128 Information on Part D plans
  

• 42 CFR 422.2260 Communications and marketing definitions for MA plans
  

• 42 CFR 423.2260 Communications and marketing definitions for Part D plans
  

• CMS Medicare Advantage and Part D Program Audit Protocols