Redetermination of Part D Low-Income Subsidy Eligibility for 2025

Relevant to: Part D Sponsors

 This is the annual routine guidance with information to plan sponsors about: 

  • The process used by the Centers for Medicare & Medicaid Services (CMS) and the SocialSecurity Administration (SSA) to redetermine Medicare beneficiaries’ low-income subsidy (LIS) eligibility;
  • An optional grace period for individuals who will no longer automatically qualify for thePart D LIS in 2025;
  • A special enrollment period (SEP) for individuals who lose their LIS eligibility;
  • CMS’ expectations regarding Part D sponsors’ responsibility for conducting outreach to members who no longer automatically qualify for LIS in 2025 and steps sponsors may take to ease their members’ transition; and
  • Two files from CMS to all Part D plan sponsors identifying individuals whom CMS has notified about their loss of LIS in 2025.

See the full guidance for more information.