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What is meant by the Medicare Part D abbreviations: EA BA DS AE in the plan benefit type?


Stand-alone Medicare Part D prescription drug plans (PDPs) can be categorized according to how they conform to the standard definded Medicare Part D definition (for example, standard deductible, fixed 25% cost-sharing, standard Initial Coverage Limit).  So Part D plans are divided into group as defined standard (DS), actuarially equivalent (AE) standard, or basic alternative (BA) - and benefits for these plans are are actuarially equivalent to the CMS defined standard Part D benefit.  However, Enhanced alternative (EA) Medicare Part D plans plans exceed or deviate from the defined standard coverage.

We show the annual number of Medicare Part D plans broken into Medicare Part D Benefit Types and this information is shown in PDP-Facts.com, our online annual summary of stand-alone Part D Plan statistics (National and State) are defined by the Center for Medicare and Medicaid Services (CMS) as follows:
  • defined standard (DS) Medicare Part D plan benefits,
  • actuarially equivalent (AE) standard benefits,
  • basic alternative (BA) benefits, and
  • enhanced alternative (EA) coverage
"These terms were intended to provide explicit guidance on permissible benefit design parameters for [Medicare Part D prescription drug plan] sponsors and actuaries. The first three benefit types are considered basic prescription drug coverage, and are actuarially equivalent to the defined standard benefit established in statute. These basic benefit designs vary only in terms of whether cost sharing tiers are applied versus one level of coinsurance, the deductible is lowered or eliminated, and the initial coverage limit is increased."

The information paraphrased below is from Chapter 5 of CMS Publication 100-18 Medicare Prescription Drug Benefit Manual which gives more details regarding the Medicare Part D benefit types:
  • Defined standard (DS) benefits

    A Medicare Part D plan that has an annual deductible, has 25% coinsurance in the initial coverage phase, beneficiary is 100% responsible for costs in coverage gap.  This features of the standard defined plan are updated and released annually by CMS: https://q1medicare.com/PartD-The-MedicarePartDOutlookAllYears.php
  • Actuarially equivalent (AE) standard benefits

    A Medicare Part D plan that has an annual deductible, the plan may substitute certain cost-sharing requirements in defined standard coverage including tiered structures tied to plan formularies or preferred pharmacies in a plan's network.
  • Basic alternative (BA) benefits

    A Medicare Part D plan that may have a reduced or $0 deductible, can use tiered co-payments or coinsurance, may have a modification to the initial coverage limit. Remains actuarially equivalent to the standard benefit.
  • Enhanced alternative (EA) coverage

    A Medicare Part D plan whose value exceeds that of the defined standard coverage.  The plan design includes the basic prescription drug coverage and has supplemental benefits which may include: a reduction in cost-sharing in the "coverage gap", a reduction in or elimination of the initial deductible, a reduction in the coinsurance or co-payments applicable during the initial coverage phase, an increase in the initial coverage limit, and/or supplemental drugs.
See: (https://www.cms.hhs.gov/PrescriptionDrugCovContra/Downloads/PDMChap5BeneProtections.pdf)





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Tips & Disclaimers
  • The Medicare Advantage and Medicare Part D prescription drug plan data on our site comes directly from Medicare and is subject to change.
  • Medicare has neither reviewed nor endorsed the information on our site.
  • We provide our Q1Medicare.com site for educational purposes and strive to present unbiased and accurate information. However, Q1Medicare is not intended as a substitute for your lawyer, doctor, healthcare provider, financial advisor, or pharmacist. For more information on your Medicare coverage, please be sure to seek legal, medical, pharmaceutical, or financial advice from a licensed professional or telephone Medicare at 1-800-633-4227.
  • We are an independent education, research, and technology company. We are not affiliated with any Medicare plan, plan carrier, healthcare provider, or insurance company. We are not compensated for Medicare plan enrollments. We do not sell leads or share your personal information.
  • Benefits, formulary, pharmacy network, provider network, premium and/or co-payments/co-insurance may change on January 1 of each year. Our PDP-Compare.com and MA-Compare.com provide highlights of annual plan benefit changes.
  • The benefit information provided is a brief summary, not a complete description of benefits. For more information contact the plan.
  • Limitations, copayments, and restrictions may apply.
  • We make every effort to show all available Medicare Part D or Medicare Advantage plans in your service area. However, since our data is provided by Medicare, it is possible that this may not be a complete listing of plans available in your service area. For a complete listing please contact 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day/7 days a week or consult www.medicare.gov.
  • When enrolling in a Medicare Advantage plan, you must continue to pay your Medicare Part B premium.
  • Medicare beneficiaries with higher incomes may be required to pay both a Medicare Part B and Medicare Part D Income Related Monthly Adjustment Amount (IRMAA). Read more on IRMAA.
  • Medicare Advantage plans that include prescription drug coverage (MAPDs) are considered Medicare Part D plans and members with higher incomes may be subject to the Medicare Part D Income Related Monthly Adjustment Amount (IRMAA), just as members in stand-alone Part D plans. In certain situations, you can appeal IRMAA.
  • You must be enrolled in both Medicare Part A and Part B to enroll in a Medicare Advantage plan. Members may enroll in a Medicare Advantage plan only during specific times of the year. Contact the Medicare plan for more information.
  • If you are enrolled in a Medicare plan with Part D prescription drug coverage, you may be eligible for financial Extra Help to assist with the payment of your prescription drug premiums and drug purchases. To see if you qualify for Extra Help, call: 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048, 24 hours a day/ 7 days a week or consult www.medicare.gov; the Social Security Office at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY users should call, 1-800-325-0778; or your state Medicaid Office.
  • Medicare evaluates plans based on a 5-Star rating system. Star Ratings are calculated each year and may change from one year to the next.
  • A Medicare Advantage Private Fee-for-Service plan (PFFS) is not a Medicare supplement plan. Providers who do not contract with the plan are not required to see you except in an emergency.
  • Disclaimer for Institutional Special Needs Plan (SNP): This plan is available to anyone with Medicare who meets the Skilled Nursing Facility (SNF) level of care and resides in a nursing home.
  • Disclaimer for Dual Eligible (Medicare/Medicaid) Special Needs Plan (SNP): This plan is available to anyone who has both Medical Assistance from the State and Medicare. Premiums, co-pays, co-insurance, and deductibles may vary based on the level of Extra Help you receive. Please contact the plan for further details.
  • Disclaimer for Chronic Condition Special Needs Plan (SNP): This plan is available to anyone with Medicare who has been diagnosed with the plan specific Chronic Condition.
  • Medicare MSA Plans combine a high deductible Medicare Advantage Plan and a trust or custodial savings account (as defined and/or approved by the IRS). The plan deposits money from Medicare into the account. You can use this money to pay for your health care costs, but only Medicare-covered expenses count toward your deductible. The amount deposited is usually less than your deductible amount, so you generally have to pay out-of-pocket before your coverage begins.
  • Medicare MSA Plans do not cover prescription drugs. If you join a Medicare MSA Plan, you can also join any separate (stand-alone) Medicare Part D prescription drug plan
  • There are additional restrictions to join an MSA plan, and enrollment is generally for a full calendar year unless you meet certain exceptions. Those who disenroll during the calendar year will owe a portion of the account deposit back to the plan. Contact the plan provider for additional information.
  • Medicare beneficiaries may enroll through the CMS Medicare Online Enrollment Center located at www.medicare.gov.
  • Medicare beneficiaries can file a complaint with the Centers for Medicare & Medicaid Services by calling 1-800-MEDICARE 24 hours a day/7 days or using the medicare.gov site. Beneficiaries can appoint a representative by submitting CMS Form-1696.