Under the Medicare Part D program, employers who offer prescription drug coverage are required to provide an annual notice. It must be sent to those Medicare Part D eligible individuals who are covered by, or who apply for, prescription drug coverage under the group health plan.
In addition, plan sponsors are required to provide notices of creditable coverage to the Centers for Medicare & Medicaid Services (CMS) on an annual basis.
Here is a brief overview of the disclosure deadlines and requirements:
Timing of Disclosure Notices
At a minimum, disclosure notices must be provided at the following times:
- Prior to the Medicare Part D Annual Coordinated Election Period: Oct. 15 – Dec. 7
- Prior to an individual’s Initial Enrollment Period for Part D
- Prior to the effective date of coverage for any Medicare eligible individual that joins the plan
- When prescription drug coverage ends or changes so that it is no longer creditable or becomes creditable
- Upon a beneficiary’s request
Content of Disclosures
CMS has provided model disclosure notices for plan sponsors to use when disclosing their creditable coverage status to Medicare beneficiaries.
Please visit the CMS’ website to view and download the model disclosure notices.
Who Must Receive a Disclosure Notice?
Disclosure notices must be provided to all Part D eligible individuals who are covered under, or who apply for, the plan’s prescription drug coverage, regardless of whether the prescription drug coverage is primary or secondary to Medicare Part D. The disclosure notice requirement applies to Medicare beneficiaries who are active or retired employees, disabled or on COBRA, as well as Medicare beneficiaries who are covered as a spouse or dependent.
An individual is eligible for Medicare Part D if he or she:
- Is entitled to Medicare Part A and/or enrolled in Part B as of the effective date of coverage under the Part D plan
- Resides in the service area of a prescription drug plan or Medicare Advantage plan that provides prescription drug coverage
To simplify plan administration, plan sponsors often decide to provide the disclosure notice to all plan participants.
Disclosure to CMS
Plan sponsors are also required to disclose to CMS whether their prescription drug coverage is creditable or non-creditable. The disclosure must be made to CMS on an annual basis, or upon any change that affects whether the coverage is creditable. At a minimum, the CMS Creditable Coverage Disclosure Notice must be provided at the following times:
- Within 60 days after the beginning date of the plan year for which the entity is providing the form
- Within 30 days after the termination of the prescription drug plan
- Within 30 days after any change in the creditable coverage status of the prescription drug plan
For additional information on this requirement, please visit the CMSCreditable Coverage Disclosure webpage.
I hope that you find this overview helpful as you seek to meet your company’s compliance requirements.
If you have additional questions, please contact the CBG Benefits team at 781-759-1222 or via email at info@CBGBenefits.com.