Opinion ID: 2338924
Heading Depth: 1
Heading Rank: 4

Heading: Overview of the Medicare Act

Text: The Medicare Act creates a federally subsidized nationwide health insurance program for elderly and disabled individuals. The Act is separated into four broad parts: Part A (hospital insurance), Part B (medical insurance), Part C (Medical Advantage Plans), and Part D (prescription drug coverage). Title VII of the Social Security Act, 42 U.S.C. §§ 1395-1395hhh (2006). Pursuant to Part C, private entities may provide the federal insurance benefits to enrollees under Parts A and B through what are often referred to as Part C Plans or Medicare Advantage [MA] Plans. Private companies that offer these plans are referred to as MA Organizations. 42 C.F.R. § 422.2 (2010). MA Organizations and their plans contract with, and are subject to extensive regulation by, the Centers for Medicare and Medicaid Services (CMS). See, e.g., 42 U.S.C. § 1395w-26(b)(1). CMS renews its contracts with MA organizations on an annual basis. See 42 C.F.R. § 422.505(c). Pursuant to federal law, Medicare enrollees may choose each year to receive benefits from the government-run Medicare plan or from one of the various MA plans offered by private MA organizations. See 42 C.F.R. § 422.62. As part of the annual reselection process, the MA organization providing benefits must present its enrollees with a document referred to as an Evidence of Coverage, or EOC, which provides the terms and conditions of the contract between the MA organization and the enrollee for the given year-long coverage period. All EOCs must be reviewed and approved by CMS prior to distribution. See 42 C.F.R. §§ 422.2260, 422.2262. Among other things, CMS must review the adequacy of formatting and font size, as well as the accuracy of the descriptions and information provided. [2] 42 C.F.R. §§ 422.2262(a), 422.2264(a). Broadly speaking, CMS's role is analogous to the inquiry Nevada courts make when considering an unconscionability argument. See D.R. Horton, Inc. v. Green, 120 Nev. 549, 554, 96 P.3d 1159, 1162 (2004) (A clause is procedurally unconscionable when ... its effects are not readily ascertainable upon a review of the contract.). With this framework in mind, we proceed to address the issues on appeal.