What is the Summary of Benefits document?

This document is a required and concise detailing of health plans that fall under the category of Medicare Advantage or Part D Prescription plan types. Limited other plan types outside of Medicare Advantage and Part D plans are also required to provide a Summary of Benefits document, such as Cost Plans. While the Summary of Benefits document is not built from a CMS-issued template, CMS’ requirements include that the plan’s details must reflect Part C and Part D benefits and beneficiary cost-sharing. Insurers may add additional plan benefits beyond those required. Specific rules for the SB are provided in the Medicare Communications and Marketing Guidelines (MCMG). Note that the SB document and its rules are separate from the similarly-named ”Summary of Benefits and Coverage” document (referred to as the SBC), which applies to plans issued under the Affordable Care Act (ACA).

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