Medicare Part D notices (of either creditable or non-creditable coverage) are due for distribution prior to October 15th.
Under the Medicare Modernization Act of 2003, employers who offer prescription drug coverage to any Medicare Part D eligible individuals must notify those individuals whether the offered prescription drug coverage is creditable coverage, meaning whether the coverage is expected to pay on average as much as the standard Medicare prescription drug coverage. Medicare Part D eligible individuals may include active employees, COBRA beneficiaries, retirees, and any of their spouses and dependents. This requirement is applicable to all employers, regardless of size or funding mechanism.
Due to the difficulty in ascertaining what all spouses, dependents, employees, retirees and COBRA beneficiaries may be entitled to Medicare based on age, disability or ESRD, many employers find it easiest to provide a blanket notice of creditable (or non-creditable) coverage to all individuals who are offered the employer’s prescription drug coverage. Medicare Part D notices must be provided to Medicare-eligible individuals prior to October 15th of each year.
The initial notices were due by November 15, 2005 and have been modified numerous times. The newest model notices and guidance were issued for use after April 1, 2011. Therefore, any notices sent from this point forward must conform to the new guidelines. Use of the former model notices will not suffice.
Downloads to the updated guidance (including links on how to determine creditable coverage status) can be found on the CMS website HERE. Downloads to the updated Creditable Coverage Notice and Non-Creditable Coverage Notice (both in English and Spanish) can be found on the CMS website HERE.
As a reminder, there are five instances in which such notice must be provided:
- Prior to an individual’s initial enrollment period for Part D;
- Prior to the effective date of enrollment in the employer’s prescription drug coverage;
- Upon any change in the plan’s creditable status;
- Prior to the annual election period for Part D (which begins each October 15); and
- Upon the individual’s request.
Providing the notice above is important as a late enrollment penalty will be assessed to those persons who go 63 days or longer without creditable coverage (for example, if they enroll in an employer’s prescription plan which is not as valuable as the Part D coverage instead of enrolling directly in the Medicare Part D coverage).
If the employer’s plan does not offer creditable prescription drug coverage and if the Part D eligible person enrolls in that plan instead of the Part D plan for at least 63 days, a permanent late enrollment penalty of 1% of the premium is added to the Medicare premium for each month the person does not enroll in Part D.
Please contact us if assistance is needed with the Notices of Creditable (or Non-Creditable) Coverage or with questions regarding the method of distribution.
Reminder: Submit Medicare Part D Notice to CMS
As discussed above, group health plans offering prescription drug coverage are required to disclose to all Part D-eligible individuals who are enrolled in or were seeking to enroll in the group health plan coverage whether such coverage was “actuarially equivalent”, i.e., creditable.
The regulations also require group health plan sponsors with Part D eligible individuals to submit a similar notice to the Centers for Medicare and Medicaid Services (“CMS”). Specifically, employers must electronically file these notices each year through the form supplied on the CMS website.
The filing deadline is 60 days following the first day of the plan year.
At a minimum, the Disclosure to CMS Form must be provided to CMS annually and upon the occurrence of certain other events including:
- Within 60 days after the beginning date of the plan year for which disclosure is provided;
- Within 30 days after termination of the prescription drug plan; and
- Within 30 days after any change in creditable status of the prescription drug plan.
The Disclosure to CMS Form must be completed online at the CMS Creditable Coverage Disclosure to CMS Form web page HERE.
The online process is composed of the following three steps:
- Enter the Disclosure Information;
- Verify and Submit Disclosure Information; and
- Receive Submission Confirmation.
The Disclosure to CMS Form requires employers to provide detailed information to CMS including but not limited to, the name of the entity offering coverage, whether the entity has an subsidiaries, the number of benefit options offered, the creditable coverage status of the options offered, the period coverage by the Disclosure to CMS Form, the number of Part D eligible individuals, the date of the notice of creditable coverage, and any change in creditable status.
For more information about this disclosure requirement (instructions for submitting the notice), please see the CMS website for updated guidance HERE.
As with the Part D Notices to Part D Medicare-eligible individuals, while nothing in the regulations prevents a third-party from submitting the notices (such as a TPA or insurer), the ultimate responsibility falls on the plan sponsor.
Elizabeth H. Latchana specializes in employee health and welfare benefits. Recognized for her outstanding legal work, in both 2018 and 2015, Beth was selected as “Lawyer of the Year” in Lansing for Employee Benefits (ERISA) Law by Best Lawyers, and in 2017 as one of the Top 30 “Women in the Law” by Michigan Lawyers Weekly. Contact her for more information on this reminder or other matters at 517.377.0826 or email@example.com.
Samantha A. Kopacz focuses her practice in employee health and welfare benefits. She represents employers, group health plans, insurance companies, and third party administrators in regulatory and compliance issues regarding ERISA, HIPAA, PPACA, COBRA, IRC, FMLA, and other benefit related federal and state laws. Contact her for more information on this reminder or other matters at 517.377.0868 or firstname.lastname@example.org.