Employer Requirement- Creditable Coverage Notice Due October 15

Employers who provide prescription drug coverage to those who are or may become eligible for Medicare Part D, must notify both  plan members and CMS on whether the coverage provided is deemed “creditable” or “non-creditable” per the MMA Act of 2003.  Creditable coverage means that the government considers the employer’s prescription drug coverage as good or better than the Medicare drug benefit. 


As the Plan Sponsor, employers first requirement is to notify all Medicare eligible members (employees and/or dependents) of  the group plan about the creditability status of their plan. This notice must be provided at least once per year by October 15, and various times throughout the year such as when a Medicare eligible individual joins the plan, prior to an individual's initial Part D enrollment period, and also upon request by the Medicare-eligible employee or COBRA Medicare-eligible former employee or their Medicare-eligible dependents.   

How do I know if the Prescription Coverage value of the employer-sponsored plan is creditable?  Insurance carriers provide notices that outline whether your plan(s) are creditable or not.  Many of the Rx copay plans are creditable, but often the High Deductible Health Plans, HDHP, are not.  Determinations are subject to change each year.

The government has provided model notices listed below which you can use to comply with notification rules. You must distribute the appropriate notice to your Medicare-eligible employees, dependents and Medicare-eligible COBRA beneficiaries, no later than October 15th

For Creditable Coverage Notices:

Model Individual Creditable Coverage Disclosure Notice

For Non-Creditable Notices:

Model Individual Non-Creditable Coverage Disclosure Notice

The second employer disclosure is to notify the Centers for Medicare and Medicaid Services (CMS) whether each group health plan is providing "creditable coverage" or "non-creditable coverage".  This annual notification must be provided to CMS electronically within 60 days after the first day of the plan year, and within 30 days after termination of a change of creditable status.

Click on these links to provide Notice to the government , and for Instructions.

For more information about CMS/employer requirements please visit the Centers for Medicaid and Medicare Services.

Please call Business Benefits Insurance Solutions if you have any questions or need assistance determining the status of your plans.