OMB control number
Applications for Part C Medicare Advantage, 1876 Cost Plans, and Employer Group Waiver Plans to Provide Part C Benefits (CMS-10237)
OMB 0938-0935 · HHS/CMS.
OMB 0938-0935
In order to provide health benefits to Medicare beneficiaries under the Medicare Advantage Program and/or the 1876 Cost Plan, applicant must meet regulatory requirements to enter into a contract with CMS, or to continue to contract with CMS. The revised Part C application is created to capture the applicants’ information.
The latest form for Applications for Part C Medicare Advantage, 1876 Cost Plans, and Employer Group Waiver Plans to Provide Part C Benefits (CMS-10237) expires 2028-01-31 and is listed under ICR 202411-0938-004.
Latest Forms, Documents, and Supporting Material
| Document | Type |
|---|---|
 Form CMS-10237 CY 2026 Part C -Medicare Advantage and 1876 Cost Plan Expansion Application | Form and Instruction |
| Form CMS-10237 Applications for Part C Medicare Advantage, 1876 Cost Plans, and Employer Group Waiver Plans to Provide Part C Benefits | Form and Instruction |
| CMS-10237_Supporting Statement_Clean.docx | Supporting Statement A |
 Humana.pdf (document unavailable) | Public Comments |
| COMPLETE_CY2026 Summary of Changes.docx | Supplementary Document |
| COMPLETE_CY2026 Summary of Changes.docx | Supplementary Document |
| Responses to 60-day comments_CMS-10237_102924.docx | Supplementary Document |
| Responses to 60-day comments_CMS-10237_102924.docx | Supplementary Document |
 Applications for Part C Medicare Advantage, 1876 Cost Plans, and Employer Group Waiver Plans to Provide Part C Benefits |
Form and Instruction |
| Applications for Part C Medicare Advantage, 1876 Cost Plans, and Employer Group Waiver Plans to Provide Part C Benefits |
Form and Instruction |