Medicare Prescription Drug Coverage
To provide prescription drugs to Medicare beneficiaries through their voluntary participation in prescription drug plans, with an additional subsidy provided to lower-income beneficiaries.
General information about this opportunity
Last Known Status
Centers For Medicare and Medicaid Services, Department of Health and Human Services
Type(s) of Assistance Offered
C - Direct Payments For Specified Use; G - Insurance
Authorized under Part D of Title XVIII of the Social Security Act.
Who is eligible to apply/benefit from this assistance?
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.
Eligible 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.
What is the process for applying and being award this assistance?
Preapplication coordination is not applicable.
2 CFR 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards applies to this program. 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.
Payment will be made by CMS to the prescription drug plan sponsors.
Contact the headquarters or regional location, as appropriate for application deadlines
Approval/Disapproval Decision Time
Up to six months for plan sponsors.
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.
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.
How are proposals selected?
How may assistance be used?
Payments will be made to participating prescription drug plans.
What are the requirements after being awarded this opportunity?
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.
Other Assistance Considerations
Formula and Matching Requirements
Statutory formula is not applicable to this assistance listing.
Matching requirements are not applicable to this assistance listing.
MOE requirements are not applicable to this assistance listing.
Length and Time Phasing of Assistance
Indefinite. Monthly payments to Prescription Drug Plan sponsors combined with an annual reconciliation adjustment
Who do I contact about this opportunity?
Regional or Local Office
7500 Security Blvd
Baltimore, MD 21244 US
(Insurance) FY 18$81,103,000,000.00; FY 19 est $84,656,000,000.00; FY 20 est $105,544,000,000.00; FY 17$88,263,000,000.00; FY 16$89,102,000,000.00; -
Range and Average of Financial Assistance
Determined by plan offerings, number of enrollees, and utilization.
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.
Examples of Funded Projects