Medicare Part D Disclosure Model Notices & CMS Disclosure Instructions

Notice deadline 10/15/16

There are two steps to be compliant:

  1. Medicare eligible employees/dependents age 65 or greater must be notified by October 15th if the employer sponsored prescription drug plan meets or exceeds Medicare Part D’s prescription drug benefits (called “creditable coverage”).  The employee/dependent notices are attached along with instruction.
  • Note: Virtually all health plans pass the credibility testing. Some prescription drug plans are NOT considered creditable coverage under an H S A plan (High deductible health plan).  If you need verification of your plan passing this test so you can send the proper notices to your employees, please reach out to us and we can help.  Attached are the sample model notices that you would edit with your company info in it.
  1. Employers must go to the CMS website (see link below) to complete their responsibilities.

Here is more information on WHY you have to do this and directions as well:

The Medicare Modernization Act (MMA) requires employers whose policies include prescription drug coverage to provide a written disclosure notice to all Medicare eligible policyholders of whether such coverage is creditable. Creditable coverage means that the coverage is expected to pay, on average, as much as the standard Medicare prescription drug coverage.

This disclosure must be provided prior to October 15th, 2016 (and at various times as stated in the regulations) to:

  • Medicare eligible active working individuals and their dependents (including a Medicare eligible individual when he or she joins the plan);
  • Medicare eligible COBRA individuals and their dependents;
  • Medicare eligible disabled individuals covered under an employer’s prescription drug plan; and
  • Any retirees and their dependents.

Please see the attached Model notices available for distribution. 

Additional Disclosure Requirements
Under the law, employers must also complete an online disclosure to CMS to report the creditable coverage status of their prescription drug plan at certain intervals.

The disclosure submission process is composed of the following steps to complete the online Creditable Coverage Disclosure Form available via the following link:

Disclosure to CMS Instructions:

Step 1 -Enter the Disclosure Information

Step 2 -Verify and Submit Disclosure Information, and

Step 3 -Receive Submission Confirmation

Please see the attached ‘Disclosure to CMS Instructions’ for further information on completing the online Creditable Coverage Disclosure form.

Disclosure to CMS Instructions
Creditable Coverage Disclosure Guidance
Model Non-Creditable Coverage Disclosure Notice
Model Creditable Coverage Disclosure Notice

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