[Code of Federal Regulations] [Title 20, Volume 2] [Revised as of April 1, 2006] From the U.S. Government Printing Office via GPO Access [CITE: 20CFR418] [Page 1178-1180] TITLE 20--EMPLOYEES' BENEFITS CHAPTER III--SOCIAL SECURITY ADMINISTRATION PART 418_MEDICARE SUBSIDIES--Table of Contents Subpart D_Medicare Part D Subsidies Sec. 418.3001 What is this subpart about? Subparts A-C [Reserved] Subpart D_Medicare Part D Subsidies Introduction, General Provisions, and Definitions Sec. 418.3001 What is this subpart about? 418.3005 Purpose and administration of the program. 418.3010 Definitions. [[Page 1179]] Eligibility for a Medicare Prescription Drug Subsidy 418.3101 How do you become eligible for a subsidy? 418.3105 Who does not need to file an application for a subsidy? 418.3110 What happens when you apply for a subsidy? 418.3115 What events will make you ineligible for a subsidy? 418.3120 What happens if your circumstances change after we determine you are eligible for a subsidy? 418.3123 When is a change in your subsidy effective? 418.3125 What are redeterminations? Filing of Application 418.3201 Must you file an application to become eligible for a subsidy? 418.3205 What makes an application a claim for a subsidy? 418.3210 What is a prescribed application for a subsidy? 418.3215 Who may file your application for a subsidy? 418.3220 When is your application considered filed? 418.3225 How long will your application remain in effect? 418.3230 When will we use your subsidy inquiry as your filing date? Income 418.3301 What is income? 418.3305 What is not income? 418.3310 Whose income do we count? 418.3315 What is earned income? 418.3320 How do we count your earned income? 418.3325 What earned income do we not count? 418.3330 What is unearned income? 418.3335 What types of unearned income do we count? 418.3340 How do we count your unearned income? 418.3345 How do we determine the value of in-kind support and maintenance? 418.3350 What types of unearned income do we not count? Resources 418.3401 What are resources? 418.3405 What types of resources do we count? 418.3410 Whose resources do we count? 418.3415 How do we determine countable resources? 418.3420 How are funds held in financial institution accounts counted? 418.3425 What resources do we exclude from counting? Adjustments and Terminations 418.3501 What could cause us to increase or reduce your subsidy or terminate your subsidy eligibility? 418.3505 How would an increase, reduction or termination affect you? 418.3510 When would an increase, reduction or termination start? 418.3515 How could you qualify for a subsidy again? Determinations and the Administrative Review Process 418.3601 When do you have the right to administrative review? 418.3605 What is an initial determination? 418.3610 Is there administrative or judicial review for administrative actions that are not initial determinations? 418.3615 Will we mail you a notice of the initial determination? 418.3620 What is the effect of an initial determination? 418.3625 What is the process for administrative review? 418.3630 How do you request administrative review? 418.3635 Can anyone request administrative review on your behalf? 418.3640 How do we determine if you had good cause for missing the deadline to request administrative review? 418.3645 Can you request that the decision-maker be disqualified? 418.3650 How do we make our decision upon review? 418.3655 How will we notify you of our decision after our review? 418.3665 Can your request for a hearing or case review be dismissed? 418.3670 How will you be notified of the dismissal? 418.3675 How does our decision affect you? 418.3678 What is the process for correcting Agency clerical errors? 418.3680 What happens if your case is remanded by a Federal court? Source: 70 FR 77675, Dec. 30, 2005, unless otherwise noted. Subparts A-C [Reserved] Authority: Secs. 702(a)(5) and 1860D-1, 1860D-14 and -15 of the Social Security Act (42 U.S.C. 902(a)(5),1395w-101, 1395w-114, and - 115). [[Page 1180]] Introduction, General Provisions, and Definitions This subpart D relates to sections 1860D-1 through 1860D-24 of title XVIII of the Social Security Act (the Act) as added by section 101 of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (Pub. L. 108-173). Sections 1860D-1 through 1860D-24 established Part D of title XVIII of the Act to create a Medicare program known as the Voluntary Prescription Drug Benefit Program. Section 1860D-14, codified into the Act by section 101, includes a provision for subsidies of prescription drug premiums and of Part D cost-sharing requirements for Medicare beneficiaries whose income and resources do not exceed certain levels. The regulations in this subpart explain how we decide whether you are eligible for a Part D premium subsidy as defined in 42 CFR 423.780 and cost-sharing subsidy as defined in 42 CFR 423.782. The rules are divided into the following groups of sections according to subject content: (a) Sections 418.3001 through 418.3010 contain the introduction, a statement of the general purpose underlying the subsidy program for the Voluntary Prescription Drug Benefit Program under Medicare Part D, general provisions that apply to the subsidy program, a description of how we administer the program, and definitions of terms that we use in this subpart. (b) Sections 418.3101 through 418.3125 contain the general requirements that you must meet in order to be eligible for a subsidy. These sections set forth the subsidy eligibility requirements of being a Medicare beneficiary, of having income and resources below certain levels, and of filing an application. These sections also explain when we will redetermine your eligibility for a subsidy and the period covered by a redetermination. (c) Sections 418.3201 through 418.3230 contain the rules that relate to the filing of subsidy applications. (d) Sections 418.3301 through 418.3350 contain the rules that explain how we consider your income (and your spouse's income, if applicable) and define what income we count when we decide whether you are eligible for a subsidy. (e) Sections 418.3401 through 418.3425 contain the rules that explain how we consider your resources (and your spouse's resources, if applicable) and define what resources we count when we decide whether you are eligible for a subsidy. (f) Sections 418.3501 through 418.3515 contain the rules that explain when we will adjust or when we will terminate your eligibility for a subsidy. (g) Sections 418.3601 through 418.3680 contain the rules that we apply when you appeal our determination regarding your subsidy eligibility or our determination of whether you should receive a full or partial subsidy. They also contain the rules that explain that our decision is binding unless you file an action in Federal district court seeking review of our final decision and what happens if your case is remanded by a Federal court