describes adjustments to premiums and cost-sharing subsidies and termination of eligibility
under the Medicare Part D prescription drug program; and
explains the effects of changes in subsidy amounts for individuals.
It does not explain reporting responsibilities for eligible individuals, how to evaluate
reports of change, and compute and change subsidy amounts. Those instructions appear
in HI 03050.005.
Certain changes in an individual’s circumstances could increase or reduce a subsidy
amount or terminate eligibility for a subsidy. The six subsidy-changing events are
listed in HI
An increase in a subsidy amount means that an individual would be able to pay a lower premium
to participate in the Medicare Part D program. An increase in subsidy may also result
in a reduction in or elimination of any deductible. In certain situations, an increase
in a subsidy amount may result in a reduced copayment for covered prescription drugs
for which an individual is responsible.
A reduction in a subsidy means that an individual would have to begin to pay a premium or a higher
premium to participate in the Medicare Part D program. The individual may also have
to begin to pay a deductible and in some cases a higher copayment for covered prescription
A termination means that an individual would no longer be eligible for a subsidy under the Medicare
Part D program.
NOTE: After a termination, an individual must generally file a new application (absent a
favorable appeal decision) and meet the requirements in HI 03001.010 to qualify for a subsidy. See an exception in HI 03010.005B.2.f. for an individual who subsequently qualifies as a deemed eligible person.
Adjustments and terminations will be effective beginning in January of the next calendar
year following a periodic redetermination or the month after the month of the report
of a change that is a subsidy changing event as defined in HI 03050.005. Individuals must receive an advance written notice of intent with the effective
date of the adjustment or termination which includes their appeal rights. Appeal rights
for a reduction or termination will include the right to continue to receive a subsidy
at the established level until there is a decision on the appeal. These procedures
are explained in detail in HI 03040 ff.
HI 03000, Eligibility for the Medicare Prescription Drug Program
HI 03040, Appeals
HI 03001, Eligibility Requirements for Subsidized Medicare Part D
HI 03050, Redeterminations
HI 03050.005, Subsidy Changing Events