42 U.S.C. § 1395w–113

The monthly beneficiary premium for a prescription drug plan is the base beneficiary premium computed under paragraph (2) or (8) (as applicable) as adjusted under this paragraph.

The base beneficiary premium shall be increased by the portion of the PDP approved bid that is attributable to supplemental prescription drug benefits.

The base beneficiary premium shall be increased by the amount of any late enrollment penalty under subsection (b).

section 1395w–114 of this titleThe monthly beneficiary premium is subject to decrease in the case of a subsidy eligible individual under .

The monthly beneficiary premium shall be increased pursuant to paragraph (7).

Except as provided in subparagraphs (D), (E), and (F), the monthly beneficiary premium for a prescription drug plan in a PDP region is the same for all part D eligible individuals enrolled in the plan.

section 1395w–21(a)(2)(A)(i) of this titlesection 1395eee of this titlesection 1395w–131(f) of this titlesection 1395mm(h) of this titlesection 1395w–131(e) of this titleFor each year (beginning with 2006) the Secretary shall compute a national average monthly bid amount equal to the average of the standardized bid amounts (as defined in paragraph (5)) for each prescription drug plan and for each MA–PD plan described in . Such average does not take into account the bids submitted for MSA plans, MA private fee-for-service plan, and specialized MA plans for special needs individuals, PACE programs under (pursuant to ), and under reasonable cost reimbursement contracts under (pursuant to ).

In the case of an MA–PD plan, the portion of the accepted bid amount that is attributable to basic prescription drug coverage.

section 1395r(i) of this titleIn the case of an individual whose modified adjusted gross income exceeds the threshold amount applicable under paragraph (2) of (including application of paragraph (5) of such section) for the calendar year, the monthly amount of the beneficiary premium applicable under this section for a month after December 2010 shall be increased by the monthly adjustment amount specified in subparagraph (B).

section 1395r(i)(4) of this titleFor purposes of this paragraph, the term “modified adjusted gross income” has the meaning given such term in subparagraph (A) of , determined for the taxable year applicable under subparagraphs (B) and (C) of such section.

The Commissioner of Social Security shall make any determination necessary to carry out the income-related increase in the base beneficiary premium under this paragraph.

The formula used to determine the monthly adjustment amount specified under subparagraph (B) shall only be used for the purpose of determining such monthly adjustment amount under such subparagraph.

The base beneficiary premium for a month in 2030 or a subsequent year shall be computed under paragraph (2) without regard to this paragraph.

The percent specified under subparagraph (A) may not be less than 20 percent.

section 1395w–101(b)(2) of this titleFor purposes of this subsection, the term “uncovered month” means, with respect to a part D eligible individual, any month beginning after the end of the initial enrollment period under unless the individual can demonstrate that the individual had creditable prescription drug coverage (as defined in paragraph (4)) for any portion of such month.

Coverage under a prescription drug plan or under an MA–PD plan.

section 1315 of this titleCoverage under a medicaid plan under subchapter XIX or under a waiver under .

section 1395w–132(a)(2) of this titleCoverage under a group health plan, including a health benefits plan under chapter 89 of title 5 (commonly known as the Federal employees health benefits program), and a qualified retiree prescription drug plan (as defined in ).

section 1395w–133(b)(1) of this titleCoverage under a State pharmaceutical assistance program described in .

Coverage for veterans, and survivors and dependents of veterans, under chapter 17 of title 38.

section 1395ss of this titlesection 1395ss(p)(1) of this titleCoverage under a medicare supplemental policy under that provides benefits for prescription drugs (whether or not such coverage conforms to the standards for packages of benefits under ).

Coverage under chapter 55 of title 10.

Such other coverage as the Secretary determines appropriate.

The Secretary shall establish procedures (including the form, manner, and time) for the documentation of creditable prescription drug coverage, including procedures to assist in determining whether coverage meets the requirement of paragraph (5).

In the case of a part D eligible individual who was enrolled in prescription drug coverage of the type described in subparagraphs (B) through (H) of paragraph (4) which is not creditable prescription drug coverage because it does not meet the requirement of paragraph (5), the individual may apply to the Secretary to have such coverage treated as creditable prescription drug coverage if the individual establishes that the individual was not adequately informed that such coverage did not meet such requirement.

Subject to subparagraph (B), for purposes of this subsection, the term “continuous period of eligibility” means, with respect to a part D eligible individual, the period that begins with the first day on which the individual is eligible to enroll in a prescription drug plan under this part and ends with the individual’s death.

section 1395w–115(c)(1) of this titlesection 1395w–115(b) of this titleWith respect to late enrollment penalties imposed under subsection (b), the Secretary shall specify the portion of such a penalty that the Secretary estimates is attributable to increased actuarial costs assumed by the PDP sponsor or MA organization (and not taken into account through risk adjustment provided under or through reinsurance payments under ) as a result of such late enrollment.

section 1395w–24(d)(2)(A) of this titleIn the case of a late enrollment penalty that is collected from a part D eligible individual in the manner described in , the Secretary shall provide that only the portion of such penalty estimated under subparagraph (A) shall be paid to the PDP sponsor or MA organization offering the part D plan in which the individual is enrolled.

section 1395w–24(d)(2)(A) of this titleIn the case of a late enrollment penalty that is collected from a part D eligible individual in a manner other than the manner described in , the Secretary shall establish procedures for reducing payments otherwise made to the PDP sponsor or MA organization by an amount equal to the amount of such penalty less the portion of such penalty estimated under subparagraph (A).

section 1395w–24(d)(2) of this titlesection 1395s of this titleNotwithstanding any provision of this subsection or , subject to subparagraph (B), the amount of the income-related increase in the base beneficiary premium for an individual for a month (as determined under subsection (a)(7)) shall be paid through withholding from benefit payments in the manner provided under .

In the case where the monthly benefit payments of an individual that are withheld under subparagraph (A) are insufficient to pay the amount described in such subparagraph, the Commissioner of Social Security shall enter into agreements with the Secretary, the Director of the Office of Personnel Management, and the Railroad Retirement Board as necessary in order to allow other agencies to collect the amount described in subparagraph (A) that was not withheld under such subparagraph.