Medicare Creditable Coverage Notice Requirements

September 15, 2017

Medicare Creditable Coverage Notice Requirements

Medicare Part D: Plan Sponsors Must Provide Notices to Participants by October 15, 2017

DISCLOSURE TO INDIVIDUALS – Group health plan sponsors must provide Medicare Part D creditable coverage notices prior to October 15th, the start date of the Medicare annual enrollment period for Part D, Prescription Drug coverage. The enrollment period is October 15th – December 7th. Most plan sponsors customize the Model Medicare Part D Notices provided by the Centers for Medicare and Medicaid Services (CMS) to notify affected plan participants. The October 15th deadline applies for all group health plan sponsors that offer prescription drug benefits, regardless of plan year, plan size, employer size, grandfather status, or whether the plan is insured or self-funded.
 
The purpose of the disclosure is to inform Medicare beneficiaries of whether the employer’s drug coverage is expected to provide coverage comparable to the Medicare Part D prescription drug coverage. Medicare-eligible employees should keep the creditable coverage notice for future reference. If a Medicare-eligible employee or dependent becomes eligible for Part D and decides not to enroll because he or she has employer-sponsored coverage, a creditable coverage notice allows them to enroll in Part D later without being charged a higher premium. For individuals enrolled in a non-creditable drug plan, failure to enroll in Part D when first eligible will result in higher premium if they enroll in Part D later.
 
The Notice of Creditable Coverage must be distributed to all individuals enrolled in an employer’s group health plan that fall within one of the following categories:
     
  1. Active employees or COBRA participants over age 65 entitled to Medicare (Part A and/or B)
  2. Spouses of active employees over age 65 entitled to Medicare (Part A and/or B)
  3. Dependent children of active employees entitled to Medicare (Part A and/or B) regardless of age
  4. Retirees over age 65 entitled to Medicare (Part A and/or B)
  5. Spouses of active employees and/or retirees entitled to Medicare (Part A and/or B)
  6. Dependent children of a retiree entitled to Medicare (Part A and/or B) regardless of age

MODEL NOTICES – CMS provides model creditable coverage notices on their website. Model notices are available in both English and Spanish. Plan sponsors are not required to use the model notices. They can choose to draft their own notice as long as it contains all of the legally required elements. Morris & Garritano can provide an editable model notice that satisfies the CMS requirements.

ELECTRONIC DISTRIBUTION – Disclosures and required notices must be furnished in a manner reasonably calculated to ensure actual receipt of the material. Employers can distribute these notices electronically to participants who have the ability to access electronic documents at their regular place of work as long as those participants have access to the electronic information system on a daily basis as part of their work duties. Employers can distribute electronically under these circumstances without the participant’s consent.
 
Participants (including active employees, retirees, and former employees) who do not use a computer as an integral part of their duties must affirmatively consent to receiving disclosures through electronic media, including methods not contemplated by current regulations (e.g. online benefit administration platforms).
 
In all cases, participants must be informed that they are responsible for providing a copy of the electronic notice to their Medicare-eligible dependents covered under the group health plan.
 
DISCLOSURE TO CMS – Employers are also required to notify CMS online annually that they have sent out these Part D notices. The notice to CMS is due within 60 days after the start of the plan year, or no later than March 1 for calendar year plans.
 
Contact Morris & Garritano Director of Compliance Keith Dunlop for further information regarding this or any other health care compliance issue.