Employers providing healthcare insurance that includes prescription drug benefits are required to notify Medicare-eligible employees by October 15 of each year whether their drug benefit is "creditable coverage," meaning that it is expected to cover, on average, as much as the standard Medicare Part D prescription drug plan.
The Centers for Medicare and Medicaid Services (CMS) require that companies provide the notice before the annual Medicare Part D election period, October 15 to December 7 each year for coverage beginning January 1. The creditable-coverage notice must be given to all Part D-eligible individuals who are covered under, or apply for, an employer's prescription drug benefits plan. This requirement applies to Medicare beneficiaries who are active employees and those who are retired, as well as Medicare beneficiaries who are covered as spouses under active or retiree coverage.
There are two CMS disclosure requirements which include:
- Providing a written disclosure notice to all Medicare eligible individuals annually who are covered under a company’s prescription drug plan, prior to October 15 each year and at various times as stated in the regulations, including to a Medicare eligible individual when he/she joins the plan. This disclosure must be provided to Medicare eligible active working individuals and their dependents, Medicare eligible COBRA individuals and their dependents, Medicare eligible disabled individuals covered under your prescription drug plan and any retirees and their dependents.
- Entities must complete the Online Disclosure to CMS Form to report the creditable coverage status of their prescription drug plan. The Disclosure should be completed annually no later than 60 days from the beginning of a plan year (contract year, renewal year), within 30 days after termination of a prescription drug plan, or within 30 days after any change in creditable coverage status. This requirement does not pertain to the Medicare beneficiaries for whom entities are receiving the Retiree Drug Subsidy (RDS).
For complete guidance and sample disclosure notices for this requirement, please visit the CMS Creditable Coverage website.