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

Summary

Lists short meanings for words used in the Part D drug rules. Basic prescription drug coverage — the basic drug benefit; covered part D drug — a drug that Part D can cover; creditable prescription drug coverage — coverage that counts as good enough compared to Part D; part D eligible individual — someone allowed to enroll in Part D; fallback prescription drug plan — a backup plan when others are not available; initial coverage limit — the coverage cap set for a year before 2025 or a similar cap for nonstandard plans; insurance risk — risk usually taken only by state-licensed insurers, not payments tied to pharmacy performance; MA plan — a Medicare Advantage plan; MA–PD plan — a Medicare Advantage plan that also includes drug coverage; Medicare Prescription Drug Account — the special account used to pay Part D costs; PDP approved bid — an approved price bid by a prescription drug plan; PDP region — the geographic area used for PDPs; PDP sponsor — a certified non-government organization that runs a prescription drug plan; prescription drug plan — drug coverage offered by an approved sponsor under a contract with the government; qualified prescription drug coverage — coverage that meets Part D rules; standard prescription drug coverage — the standard Part D benefit; State Pharmaceutical Assistance Program — a state program that helps pay for drugs; subsidy eligible individual — someone who can get help paying drug costs. When a rule from Medicare Part C is applied here, read it as if it referred to Part D. Treat mentions of MA plans as prescription drug plans, MA organizations or provider-sponsored organizations as PDP sponsors, contracts under Part C as the Part D contract, Part C as this Part, and election periods as Part D enrollment periods.