Medicare D Disclosures and Notices

Centers for Medicare & Medicaid Services (CMS) under the Medicare Modernization Act (MMA) requires Group Health Plan Sponsors, whose policies include prescription drug coverage, to notify CMS and Medicare eligible individuals (employee and/or dependents) annually whether their prescription drug coverage is creditable or not.

The annual required notifications are as follows:

Notification to CMS

Employers must disclose creditable coverage status to CMS using the online Disclosure to CMS Form no later than 60 days following the beginning of the plan year (i.e. if the prescription drug plan renews/starts January 1st, the disclosure online form should be completed by March 1st).

Disclosure to CMS Form

Instructions and Screen Shots

Notification of Creditability to Employees

Notices must be provided to Medicare-eligible active working, COBRA, retiree or disabled individuals and their dependents that are covered under the prescription drug plan. Although these notices are only required if there are Medicare eligible individuals covered under the prescription drug plan, it is normally recommended to issue notices if you are not completely aware of the Medicare status of all covered members (which includes spouses and child dependents).

Notices must be provided:

  • annually, prior to the October 15th to December 7th election period “Open Enrollment” for Medicare Part D (the deadline change is due to health care reform)
  • prior to an individual’s initial enrollment period for Medicare Part D (the employer is considered compliant if a notice is sent to all plan participants annually)
  • prior to the effective date of coverage for any Medicare Part D eligible individual who enrolls in the employer’s prescription drug coverage
  • if the employer no longer offers prescription drug coverage, changes it so it is no longer creditable or becomes creditable
  • upon request by any Medicare Part D-eligible individual

For more information on Medicare D contact our Compliance Department.

DISCLOSURE

The information provided herein is intended solely for the use of our clients. You may not display, reproduce, copy, modify, license, sell or disseminate in any manner any information included herein, without the express permission of the Publisher or Publishers of articles within.

The information provided is for informational purposes only and does not constitute legal advice. The information above contains only a summary of the applicable legal provisions and does not purport to cover every aspect of any particular law, regulation or requirement. Depending on the specific facts of any situation, there may be additional or different requirements. This is to be used only as a guide and not as a definitive description of your compliance obligations.