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This variable is contained in the following files: Plan Characteristics File
SAS Name
DEMINIMIS_PD_FLAG

If beneficiaries who are eligible for Medicare and Medicaid (often called full benefit dual eligibles) enroll in Part D plans with premiums higher than the regional benchmark, they are responsible for paying the premium amount above the benchmark. The benchmark is a statutorily defined amount that is based on the average premium amounts for Part D plans for each region (varies by year).

This variable indicates whether the Part D sponsor has voluntarily waived the portion of the monthly adjusted basic beneficiary premium that is a de minimis amount above the low-income subsidy (LIS) premium benchmark for subsidy-eligible individuals.

LIS individuals who enroll in plans that waive the de minimis premium amount are charged a monthly beneficiary premium for basic prescription drug coverage rather than for the higher de minimis amount (i.e., full benefit dual eligible beneficiaries have a full premium subsidy and would essentially have $0 premium payment).

Comments

The Part D premium benchmarks vary by region. The de minimis amount is $2.00.

The CCW constructs the Plan Characteristics File from information submitted by plan sponsors to CMS’s Health Plan Management System (HPMS).

Provisions in the Patient Protection and Affordable Care Act of 2010 (ACA) changed the way benchmarks are calculated to improve continuity of Part D plan enrollment for LIS beneficiaries. Refer to the CMS Medicare Prescription Drug Benefit Manual for additional details (see, for example: http://www.cms.gov/Medicare/Prescription-DrugCoverage/PrescriptionDrugCovContra/PartDManuals.html)

Employer and National Program of All-inclusive Care for the Elderly (PACE) plans are waived from reporting Plan Benefit Package information.

For those plans that did not report, the value of this variable will be blank.

Source: CMS (HPMS Files)

CodeCode value
Y
Yes
N
No
9
Not Applicable