Assistance Listings Medicare Prescription Drug Coverage
Overview
Objectives
To provide prescription drugs to Medicare beneficiaries through their voluntary participation in prescription drug plans, with an additional subsidy provided to lower-income beneficiaries.
Examples of Funded Projects
Not Applicable.
Financial Information
| Obligation(s) | FY 23 | FY 24 (est.) | FY 25 (est.) |
|---|---|---|---|
| Insurance Total | $113,108,000,000 | $120,640,000,000 | $148,462,000,000 |
| Totals | $113,108,000,000 | $120,640,000,000 | $148,462,000,000 |
Range and Average of Financial Assistance
Determined by plan offerings, number of enrollees, and utilization.
Accomplishments
Not Applicable.
Account Identification
75-8308-0-7-571
Criteria for Applying
Types of Assistance
G - Insurance
Credentials and Documentation
Applicant Eligibility
Designations
Native American Organizations (includes lndian groups, cooperatives, corporations, partnerships, associations)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.
Beneficiary Eligibility
Designations
Individual/Family, Minority group, Disabled (e.g. Deaf, Blind, Physically Disabled), Physically Afflicted (e.g. TB, Arthritis, Heart Disease), Mentally Disabled, Low IncomeEligible 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.
Length and Time Phasing of Assistance
Indefinite. Method of awarding/releasing assistance: Monthly payments to Prescription Drug Plan sponsors combined with an annual reconciliation adjustment
Use of Assistance
Designations
Health/MedicalPayments will be made to participating prescription drug plans.
Applying for Assistance
Deadlines
Contact the headquarters or regional location, as appropriate for application deadlines
Preapplication Coordination
Preapplication coordination is not applicable. Environmental impact information is not required for this program. This program is excluded from coverage under E.O. 12372.
Application Procedures
This program is excluded from coverage under 2 CFR 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards. 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.
Criteria for Selecting Proposals
Not Applicable.
Award Procedure
Payment will be made by CMS to the prescription drug plan sponsors.
Date Range for Approval/Disapproval
Up to six months for plan sponsors.
Renewals
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.
Appeals
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.
Compliance Requirements
Policy Requirements
Not Applicable
Subpart B, General provisions
Subpart C, Pre-Federal Award Requirements and Contents of Federal Awards
Subpart D, Post Federal; Award Requirements
Subpart E, Cost Principles
Subpart F, Audit Requirements
Additional Information:
Reports
Program Reports: Plans must provide periodic reports to CMS, enrollees and the general public on cost; utilization; availability, accessibility and acceptability of services; fiscal soundness and other information required by CMS. Cash Reports: Plans must provide an annual report of business transactions and combined financial statements.
Audits
Additional audit requirements:
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.
Records
None.
Regulations, Guidelines, and Literature
Regulations governing this program are authorized under Part D of Title XVIII of the Social Security Act and are available at 42 CFR 423.
Formula and Matching Requirements
Contact Information
Regional or Local Locations:
None.Headquarters Office:
History
- 2024Published
Medicare Prescription Drug Coverage
- 2023Published
Medicare Prescription Drug Coverage
- 2022Published
Medicare Prescription Drug Coverage
- 2021Published
Medicare Prescription Drug Coverage
- 2020Published
Medicare Prescription Drug Coverage
- 2019Published
Medicare Prescription Drug Coverage
- 2018Published
Medicare Prescription Drug Coverage
- 2005Published
Medicare_Prescription Drug Coverage