Reminder: DUA and VRDC access needs to be extended or renewed annually. Read more.
This variable is contained in the following files:
Master Beneficiary Summary File (MBSF) Base A/B/C/D V2 Accountable Health Communities (AHC) Model Oncology Care Model (OCM) Current Clinical Status File Oncology Care Model (OCM) Clinical and Staging File Oncology Care Model (OCM) Medicare Bayesian Improved Surname Geocoding (MBISG) Acute Hospital Care at Home (AHCAH) - Patient Acute Hospital Care at Home (AHCAH) - Hospital Inpatient Rehab Facility-Patient Assessment Instrument TAF Demographic and Eligibility File Million Hearts® Cardiovascular Disease Risk Reduction (Million Hearts®) Model Alignment Files Million Hearts® Cardiovascular Disease Risk Reduction (Million Hearts®) Model Provider List File Million Hearts® Cardiovascular Disease Risk Reduction (Million Hearts®) Model Practice List File Million Hearts® Cardiovascular Disease Risk Reduction (Million Hearts®) Model Visit File Million Hearts® Cardiovascular Disease Risk Reduction (Million Hearts®) Model Beneficiary Demographic File Million Hearts® Cardiovascular Disease Risk Reduction (Million Hearts®) Model Final Clinical File Million Hearts® Cardiovascular Disease Risk Reduction (Million Hearts®) Model Raw Clinical File Million Hearts® Cardiovascular Disease Risk Reduction Model CMMI Model Data Sharing (CMDS) Beneficiary File CMMI Model Data Sharing (CMDS) Provider File CMMI Model Data Sharing (CMDS) Entity File CMMI Model Data Sharing (CMDS) Model Participation Data Initiative Healthcare Effectiveness Data and Information Set (HEDIS) File 2: Plan All-Cause Readmission (PCR) Measure Healthcare Effectiveness Data and Information Set (HEDIS) File 1: Measures File (does not include Plan All-Cause Readmission measure) MBSF 30 CCW Chronic Conditions Next Generation ACO Model Provider RIF Next Generation ACO Model Beneficiary RIF Medicare-Medicaid Linked Enrollee Analytic Data Source (MMLEADS) 3.0 TAF Annual Managed Care Plan (APL) TAF Annual Provider (APR) Comprehensive ESRD Care (CEC) Model - Provider Comprehensive ESRD Care (CEC) Model - Beneficiary Home Health Outcome and Assessment Information Set (OASIS) Long Term Care Minimum Data Set (MDS) 2.0 Plan Characteristics File Long Term Care Minimum Data Set (MDS) 3.0 Long Term Care Minimum Data Set (MDS) - Swing-Bed 3.0 MAX Personal Summary File Medicare-Medicaid Linked Enrollee Analytic Data Source (MMLEADS) 2.0 TAF Pharmacy File TAF Other Services File TAF Long Term Care File TAF Inpatient File Skilled Nursing Facility (Encounter) Outpatient (Encounter) Inpatient (Encounter) Home Health Agency (Encounter) Durable Medical Equipment (Encounter) Carrier (Encounter) Risk Score Files Value Modifier Practice-Level File Value Modifier Beneficiary-Level File Medicare Shared Savings Program Accountable Care Organizations (ACO) Beneficiary-level RIF Medicare Shared Savings Program Accountable Care Organizations (ACO) Provider-level RIF Pioneer Accountable Care Organization (ACO) Medicare Data on Provider Practice and Specialty (MD-PPAS) Healthcare Effectiveness Data and Information Set (HEDIS) Long Term Care Minimum Data Set (MDS) - Swing-Bed 2.0 Consumer Assessment of Healthcare Providers & Systems RIF National Health and Aging Trends Study (NHATS) - Medicare Linked Data Health and Retirement Survey - Medicare Linked Data Health Outcomes Survey RIF Medicaid Enrollee Supplemental File (MESF): National Death Index (NDI) Segment Medicaid Enrollee Supplemental File (MESF): Conditions Segment MBSF Other Chronic or Potentially Disabling Conditions MBSF National Death Index (NDI) MBSF Cost and Use MBSF 27 CCW Chronic Conditions MBSF Base A/B/C/D MAX Long Term Care File MAX Inpatient File MAX Other Services File MAX Prescription Drug File Value Modifier NPI Practice-Level File Part D Medication Therapy Management Data File Part D Plan Election Type Beneficiary Summary File Part D Event (PDE) File Part D Formulary File Part D Pharmacy Characteristics File Part D Prescriber Characteristics File Part D Drug Characteristics File Carrier (Fee-for-Service) Durable Medical Equipment (Fee-for-Service) Home Health Agency (Fee-for-Service) Hospice (Fee-for-Service) Inpatient (Fee-for-Service) Outpatient (Fee-for-Service) Skilled Nursing Facility (Fee-for-Service) Medicare Provider Analysis and Review (MedPAR)
SAS Name
CST_SHR_GRP_CD_06
This variable indicates the beneficiary’s Part D low-income subsidy cost sharing group for a given month (June). The Part D benefit requires enrollees to pay both premiums and cost-sharing, but the program also has a low-income subsidy (LIS) that covers some or all of those costs for certain low-income individuals, including deductibles and cost-sharing during the coverage gap.
| Code | Code value |
|---|---|
| 00 | Not Medicare enrolled for the month |
| 01 | Beneficiary enrolled in Parts A and/or B, and Part D; deemed eligible for LIS with 100% premium subsidy and no copayment |
| 02 | Beneficiary enrolled in Parts A and/or B, and Part D; deemed eligible for LIS with 100% premium subsidy and low copayment |
| 03 | Beneficiary enrolled in Parts A and/or B, and Part D; deemed eligible for LIS with 100% premium subsidy and high copayment |
| 04 | Beneficiary enrolled in Parts A and/or B, and Part D; enrolled in LIS with 100% premium subsidy and high copayment |
| 05 | Beneficiary enrolled in Parts A and/or B, and Part D; enrolled in LIS with 100% premium subsidy and 15% copayment |
| 06 | Beneficiary enrolled in Parts A and/or B, and Part D; enrolled in LIS with 75% premium subsidy and 15% copayment |
| 07 | Beneficiary enrolled in Parts A and/or B, and Part D; enrolled in LIS with 50% premium subsidy and 15% copayment |
| 08 | Beneficiary enrolled in Parts A and/or B, and Part D; enrolled in LIS with 25% premium subsidy and 15% copayment |
| 09 | Beneficiary enrolled in Parts A and/or B, and Part D; no premium or cost sharing subsidy |
| 10 | Beneficiary enrolled in Parts A and/or B, but not Part D enrolled; employer receives RDS subsidy |
| 13 | Beneficiary enrolled in Parts A and/or B, but not Part D enrolled. It is unknown whether the beneficiary has creditable prescription drug coverage elsewhere. |
| Null/missing | Beneficiary was not found in cost sharing group data |
CMS identifies beneficiaries with fully-subsidized Part D coverage by looking for individuals that have a 01, 02, or 03 for the month. Other beneficiaries who are eligible for the LIS but do not receive a full subsidy have a 04, 05, 06, 07, or 08. The remaining values indicate that the individual is not eligible for subsidized Part D coverage. There are 12 monthly variables — where the 01 through 12 at the end of the variable name correspond with the month (e.g., 01 is January and 12 is December).
There is a late enrollment penalty for those who are eligible for Part D but choose not to enroll for any given year and do not have creditable coverage for that time. A number of Medicare-eligible beneficiaries may have access to other types of prescription drug plans. Creditable prescription drug coverage includes, but is not limited to: employer-based prescription drug coverage, including the Federal Employees Health Benefits Program (FEHB); qualified State Pharmaceutical Assistance Programs (SPAPs); military-related coverage (e.g., VA, TRICARE); and certain Medicare supplemental (Medigap) policies. For additional details regarding the creditable coverage provision of the Part D benefit, please refer to the CMS website at: https://www.cms.gov/medicare/prescription-drug-coverage/creditablecover….
Source: CMS Common Medicare Environment (CME)