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This variable is contained in the following files:
SAS Name
CST_SHR_GRP_CD_09
This variable indicates the beneficiary’s Part D low-income subsidy cost sharing group for a given month (September). 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)