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Medicare Advantage Plan – Health benefits coverage offered under a policy or contract by an MAO that includes a specific set of health benefits offered at a uniform premium and uniform level of cost-sharing to all Medicare beneficiaries residing in the service area of the MA plan (or in individual segments of a service area, under 42 CFR § 422.304(b)(2)).

Medicare Cost Plan – A plan operated by a Health Maintenance Organization (HMO) or Competitive Medical Plan (CMP) in accordance with a cost-reimbursement contract under Section 1876(h) of the Act.

Out-of-Area Members – Members of an MA plan who live outside the service area and who elected the MA plan while residing outside the service area.

Part D-Income Related Monthly Adjustment Amount (Part D-IRMAA) – A premium amount separate from the Part D plan’s monthly premium for individuals who have incomes over a certain amount. The Social Security Administration (SSA) assesses the amount annually based on the enrollee’s available tax information.

Part D Late Enrollment Penalty (LEP) – An amount added to the Part D plan premium of an individual, except as described in 42 CFR § 423.780(e), who has a break in creditable prescription drug coverage of at least 63 consecutive days after the end of the individual’s initial enrollment period, during which the individual was eligible to enroll in a Part D plan, was not covered under any creditable prescription drug coverage, and was not enrolled in a Part D plan. The Part D LEP is an additional amount added to the base beneficiary premium, along with other adjustments, to determine the monthly beneficiary premium.

Part D Plan – A prescription drug plan, an MA-PD plan, a PACE plan offering qualified prescription drug coverage, or a cost plan offering qualified prescription drug coverage.

Part D Plan Sponsor (Part D Sponsor) – A PDP sponsor, MA organization offering an MA-PD plan, a PACE organization offering a PACE plan including qualified prescription drug coverage, and a cost plan offering qualified prescription drug coverage.

Partial-Benefit Dual Eligibles or Other Low-Income Subsidy (LIS) Eligible Individuals – For purposes of Medicare Part D benefits, individuals who are determined eligible for the Part D LIS who are not full-benefit dual eligible individuals as defined above. This includes individuals deemed eligible for LIS by virtue of having Qualified Medicare Beneficiary program (QMB)- only, Specified Low-Income Medicare Beneficiary program (SLMB)-only, Qualified Individual program (QI), Supplemental Security Income (SSI)-only; as well as those who apply and are determined eligible for LIS.

PDP Sponsor – A nongovernmental entity that is certified under this part as meeting the requirements and standards of this part that apply to entities that offer prescription drug plans. This includes fallback entities.

Permanent Residence – The enrollee’s primary residence, not necessarily the individual’s mailing address.