Monthly cost sharing group under Part D low-income subsidy - May

SAS Name
CST_SHR_GRP_CD_05

This variable indicates the beneficiary’s Part D low-income subsidy cost sharing group for a given month (May). 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.

Comments

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).

Source: CMS Common Medicare Environment (CME)

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