Medicare Prescription Drug Coverage

 

To provide prescription drugs to Medicare beneficiaries through their voluntary participation in prescription drug plans, with an additional subsidy provided to lower-income beneficiaries.

Active 93.770 Centers For Medicare and Medicaid Services, Department of Health and Human Services C - Direct Payments For Specified Use; G - Insurance Not applicable. Authorized under Part D of Title XVIII of the Social Security Act. An entity organized and licensed under State law as a risk-bearing entity eligible to offer health insurance in each State in which it is to offer a plan, meeting the requirements in 42 CFR 423.504 and 42 CFR 423.505. The entity may offer prescription drug coverage in conjunction with a Medicare Advantage plan or as a separate standalone benefit. Eligible beneficiaries include individuals who are entitled to Medicare benefits under Part A or enrolled in Part B and who reside in the plan's service area. Individuals in a Medicare Advantage Plan with Part D coverage may not be separately enrolled in a stand alone prescription drug plan. Not applicable. Preapplication coordination is not applicable. 2 CFR 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards applies to this program. Potential sponsors apply to CMS to become an approved prescription drug plan. Generally, individuals enroll directly with the prescription drug program sponsor. The sponsor forwards the enrollment and eligibility information to CMS, which verifies eligibility for the drug benefit. Some individuals who are entitled to both Medicare and Medicaid have been enrolled automatically. Low income beneficiaries may complete a subsidy application at any Social Security office or through their State Medicaid office. Payment will be made by CMS to the prescription drug plan sponsors. Contact the headquarters or regional location, as appropriate for application deadlines Up to six months for plan sponsors. Sponsors whose applications to become a prescription drug plan sponsor are rejected have the right to a reconsideration and appeal process. Beneficiaries have the right to a reconsideration and appeal process for adverse coverage determinations. Contracts with sponsors may be renewed annually. Beneficiaries may enroll and disenroll from plans according to the timeframes established in 42 CFR 423.30-423.46. Not applicable. Payments will be made to participating prescription drug plans. Not applicable. Periodic audits of plans by HHS, the Comptroller General or their designees. Periodic audits by CMS and the HHS Office of Inspector General (OIG) of plan cost reporting. Audit by CMS of financial records of at least one-third of participating plans every year. None. Statutory formula is not applicable to this assistance listing.

Matching requirements are not applicable to this assistance listing.

MOE requirements are not applicable to this assistance listing. Indefinite. Monthly payments to Prescription Drug Plan sponsors combined with an annual reconciliation adjustment None/Not specified. Tiffany Walker
7500 Security Boulevard
Baltimore, MD 21244 US
Tiffany.Walker@cms.hhs.gov
Phone: 4107864724 http://www.cms.hhs.gov 75-8308-0-7-571 (Insurance) FY 22$114,133,000,000.00; FY 23 est $113,269,000,003.00; FY 24 est $114,180,000,000.00; FY 21$98,760,000,000.00; FY 20$95,545,000,000.00; FY 18$81,103,000,000.00; FY 19 est $84,656,000,000.00; FY 17$88,263,000,000.00; FY 16$89,102,000,000.00; - Determined by plan offerings, number of enrollees, and utilization. Regulations governing this program are authorized under Part D of Title XVIII of the Social Security Act and are available at 42 CFR 423. Not applicable.