Medicare Part D Disclosure to CMS due by February 29, 2016 for Calendar Year Plans

Each year, group health plan sponsors are required to disclose to the Centers for Medicare and Medicaid Services (CMS) whether the plan’s prescription drug coverage is creditable.  The disclosure must be submitted no later than 60 days following the first day of the plan year.  For calendar year plans, the deadline for completion is February 29, 2016.

Employers subject to the disclosure requirement are those whose plan provides prescription drug coverage and covers any Medicare-eligible individual – including employees, spouses, dependents, and COBRA participants – at the start of the plan year.  These employers must complete an online disclosure form to CMS to indicate whether the prescription coverage offered under the plan is creditable or non-creditable.  

Generally, a group health plan’s drug coverage is considered creditable if the expected amount of paid claims under the plan meets or exceeds the expected amount of paid claims under the Medicare Part D prescription drug benefit.  Though the status of creditable or non-creditable coverage is an actuarial determination, insurance carriers often provide such information.

In addition to the annual disclosure to CMS within 60 days of the start of the plan year, employers are required to make a subsequent disclosure within 30 days following any change in the plan’s creditable coverage status, including termination of coverage. 

Lastly, the disclosure to CMS is a requirement that is separate from the annual disclosure notice due to plan participants, and is also separate from any request received from CMS to complete the IRS-SSA-CMS Data Match to assist in identifying claims for which a plan other than Medicare is primary.