§1395w–151 Definitions; Treatment of References to Provisions in Part C

Summary

Defines words used for Medicare prescription drug plans and says how some Part C rules should be read for Part D. It lists key terms and what they mean in short: basic prescription drug coverage (the basic kind of drug benefit), covered Part D drug (a drug covered under Part D), creditable prescription drug coverage (coverage that counts as good enough), Part D eligible individual (who can join Part D), fallback prescription drug plan (a backup plan), initial coverage limit (the dollar limit used before 2025, or the similar limit for nonstandard plans), insurance risk (the kind of risk insurers take, not including payment tied to pharmacy performance), MA plan and MA–PD plan (Medicare Advantage related plans), Medicare Prescription Drug Account (the special account for drug funds), PDP approved bid (an approved price bid for a plan), PDP region (the geographic region for a plan), PDP sponsor (an approved organization that runs a drug plan), prescription drug plan (a PDP that meets approval and has a contract with the Secretary), qualified prescription drug coverage, standard prescription drug coverage, State Pharmaceutical Assistance Program, and subsidy eligible individual. When applying rules written for Part C to Part D plans, read those references as if they meant Part D: treat “MA plan” as a prescription drug plan, “MA organization” or “provider-sponsored organization” as a PDP sponsor, MA contract rules as PDP contract rules, references to Part C as references to Part D, and an “election period” as an “enrollment period.”