Assuring at least actuarially equivalent coverage
(A) Assuring equivalent value of total coverage
(A)Assuring equivalent value of total coverage#
The actuarial value of the total coverage is at least equal to the actuarial value of standard prescription drug coverage.
(B)Assuring equivalent unsubsidized value of coverage#
The unsubsidized value of the coverage is at least equal to the unsubsidized value of standard prescription drug coverage. For purposes of this subparagraph, the unsubsidized value of coverage is the amount by which the actuarial value of the coverage exceeds the actuarial value of the subsidy payments under section 1395w–115 of this title with respect to such coverage.
(C)Assuring standard payment for costs#
The coverage is designed, based upon an actuarially representative pattern of utilization, to provide for the payment, with respect to costs incurred that are equal to the initial coverage limit under subsection (b)(3) for the year for a year preceding 2025 or the annual out-of-pocket threshold specified in subsection (b)(4)(B) for the year for 2025 and each subsequent year, of an amount equal to at least the product of—
(i) the amount by which the initial coverage limit described in subsection (b)(3) for the year for a year preceding 2025 or the annual out-of-pocket threshold specified in subsection (b)(4)(B) for the year for 2025 and each subsequent year exceeds the deductible described in subsection (b)(1) for the year; and
(ii) 100 percent minus the coinsurance percentage specified in subsection (b)(2)(A)(i).
(C)(i)#
the amount by which the initial coverage limit described in subsection (b)(3) for the year for a year preceding 2025 or the annual out-of-pocket threshold specified in subsection (b)(4)(B) for the year for 2025 and each subsequent year exceeds the deductible described in subsection (b)(1) for the year; and
(C)(ii)#
100 percent minus the coinsurance percentage specified in subsection (b)(2)(A)(i).