Medicare Part D Disclosures for 2015: Creditable Coverage

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Group health plan sponsors are required to complete an online disclosure form with the Centers for Medicare & Medicaid Services (CMS) on an annual basis and at other select times, indicating whether the plan’s prescription drug coverage is creditable or non-creditable.

The plan sponsor must complete the online disclosure within 60 days after the beginning of the plan year. For calendar year health plans, the deadline for the annual online disclosure is March 1, 2015. Because March 1, 2015, is a Sunday, CMS may extend the disclosure deadline to Monday, March 2, 2015. However, CMS has not yet made this announcement. Thus, plan sponsors should plan on completing the online disclosure form by March 1, 2015.

Medicare Part D Disclosures to CMS:  Group health plan sponsors are required to disclose to CMS whether their prescription drug coverage is creditable or non-creditable. This disclosure is required whether the health plan’s coverage is primary or secondary to Medicare.

A group health plan’s prescription drug coverage is considered creditable if its actuarial value equals or exceeds the actuarial value of the Medicare Part D prescription drug coverage. In general, this actuarial determination measures whether the expected amount of paid claims under the group health plan’s prescription drug coverage is at least as much as the expected amount of paid claims under the Medicare Part D prescription drug benefit. The determination of creditable coverage does not require an attestation by a qualified actuary, except when the plan sponsor is electing the Retiree Drug Subsidy for the group health plan.

Also, if a group health plan does not offer outpatient prescription drug benefits to any Medicare-eligible individuals as of the beginning of the plan year, the group health plan is not required to submit the online disclosure form to CMS for that plan year. A plan sponsor who has been approved for the Retiree Drug Subsidy is exempt from filing the CMS disclosure notice with respect to those qualified covered retirees for whom the sponsor is claiming the Retiree Drug Subsidy.

  • Medicare Part D imposes disclosure requirements on employers whose health plans provide prescription drug coverage to Medicareeligible individuals.
  • Plan sponsors must complete an online disclosure form with CMS within 60 days after the start of the plan year, or March 1, 2015, for calendar year plans. Each year, employers whose health plans include prescription drug coverage must disclose to CMS whether that coverage is creditable or noncreditable.

Timing of Disclosures to CMS The disclosure must be made to CMS on an annual basis and upon any change that affects whether the coverage is creditable. More specifically, the Medicare Part D disclosure notice must be provided within the following time frames:

  • Within 60 days after the beginning date of the plan year for which the entity is providing the disclosure to CMS;
  • Within 30 days after the termination of a plan’s prescription drug coverage; and
  • Within 30 days after any change in the plan’s creditable coverage status.

Online Disclosure Method: Plan sponsors are required to use the online disclosure form on the CMS Creditable Coverage webpage. This is the sole method for compliance with the disclosure requirement, unless the entity does not have Internet access.

The disclosure form lists the required data fields that must be completed in order to generate the disclosure notice to CMS, such as types of coverage, number of options offered, creditable coverage status, period covered by the disclosure notice, number of Part D-eligible individuals covered, date the creditable coverage disclosure notice is provided to Part D-eligible individuals, and change in creditable coverage status. CMS has also provided instructions for detailed descriptions of these data fields and guidance on how to complete the form.

Medicare Part D Disclosures to Individuals: In addition to the annual disclosure to CMS, Medicare Part D requires group health plan sponsors to disclose to individuals who are eligible for Medicare Part D whether the plan’s prescription drug coverage is creditable. At a minimum, creditable coverage disclosure notices must be provided to individuals at the following times:

  1. Prior to the Medicare Part D annual coordinated election period—beginning Oct. 15 through Dec. 7 of each year;
  2. Prior to an individual’s initial enrollment period for Part D;
  3. Prior to the effective date of coverage for any Medicare-eligible individual who joins the plan;
  4. Whenever prescription drug coverage ends or changes so that it is no longer creditable or becomes creditable; and
  5. Upon a beneficiary’s request.

If the creditable coverage disclosure notice is provided to all plan participants annually, before Oct. 15 of each year, items (1) and (2) above will be satisfied. “Prior to,” as used above, means the individual must have been provided with the notice within the past 12 months. In addition to providing the notice each year before Oct. 15, plan sponsors should consider including the notice in plan enrollment materials provided to new hires.

For more Information on this, and all compliance issues, please contact Tim DeGeorge: tim@waldorfrisksolutions.com or call 631-423-9500.