Medicare Part D Creditable Coverage Disclosure – Which Companies Must Comply?

Question:

Medicare Part D Creditable Coverage Disclosure is due by March 1st.  How do I determine if this is something my company needs to comply with?

Answer:

It’s that time of year for many employers to disclose Medicare Part D Creditable Coverage status to the Centers for Medicare & Medicaid Services (CMS).  As a reminder, there are two disclosures required annually for certain employers related to Medicare Part D.  Employers with plans providing prescription drug coverage to individuals that are eligible for Medicare Part D must disclose whether their drug benefit is equal to or better than (also known as “creditable”) the Part D program to (1) individuals eligible for Medicare Part D and (2) to CMS.  The disclosure to CMS is due by March 1st for calendar-year plans.  At a minimum, disclosure to CMS must be made at the following times:

  • Within 60 days after the beginning of the plan year
  • Within 30 days after the termination of the prescription drug coverage
  • Within 30 days after any change in the creditable coverage status of the prescription drug plan

There are a few exceptions to the employer’s requirement to disclose Medicare D status to CMS, such as:

  • Employers not offering prescription benefits to any Medicare D eligible individuals on the beginning date of the plan year are not required to complete a disclosure to CMS form for that plan year.
  • Employers and unions that have applied and been approved for the Retiree Drug Subsidy (RDS) are exempt from filing the form. The exemption applies only to the covered members and plan options for which the employer is claiming the RDS. The plan sponsor’s RDS application will serve as disclosure to CMS.

Employers must provide the following Information on the disclosure to CMS:

  • Name of Entity
  • Federal Tax Identification Number (EIN)
  • Entity geographical information
  • Phone number of entity
  • Type of coverage
  • Creditable coverage status
  • Identify “authorized individual” of the entity

Disclosure must be made online via form CMS-10198. Further guidance and instructions for disclosure is found at CMS Creditable Coverage.

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