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Medicare Part D Notice of Creditable (or Non-Creditable) Coverage

September 2020 Benefits Brief


Plan sponsors of group health plans providing prescription drug coverage to individuals who are eligible for Medicare Part D prescription drug coverage are required to satisfy certain notice requirements.



Individuals must enroll in Medicare Part D prescription drug coverage when first eligible (generally, at age 65).  If they do not do so, they are subject to a permanently higher monthly premium when enrolling at a later date.  A key exception to this general rule is for individuals who do not enroll when initially eligible because they are already enrolled in creditable prescription drug coverage.  Coverage is considered creditable if it is at least as good or better than the actuarial value of Medicare Part D prescription drug coverage.  The required notice of creditable coverage (or notice of non-creditable coverage) is designed to help individuals determine the timing of when they must enroll in Medicare Part D.


Determining Whether a Prescription Drug Plan is Creditable

Generally, prescription drug coverage under an employer group health plan will be creditable.  There is a safe harbor method of determining creditable coverage status.  The requirements are easily satisfied.  However, for qualifying high deductible health plans (HDHPs) offered in connection with a health savings account (HSA), the HDHP may not be creditable unless it is expected to pay, on average, at least 60% of participants’ prescription drug expenses.  It may be necessary to obtain actuarial advice to make this determination in connection with an HDHP.


     CMS’ Creditable Coverage Simplified Determination


Notice Requirements





Model Non-Creditable Coverage Disclosure Notice
Model Creditable Coverage Disclosure Notice


Penalty for Noncompliance

Fortunately, there is no penalty for employer/plan sponsors who do not comply with the notice requirement.  However, if the employer provides retiree prescription drug coverage and claims a subsidy under Medicare Part D (only a minority of employers do so) providing the notice is a precondition to obtaining the subsidy.  Even though there is no penalty for noncompliance for most employers, it is still advisable to comply to assist participants in helping them to determine when they need to enroll Medicare Part D.


CMS Reporting

In addition to the participant notice requirement, employer/plan sponsors are also required to disclose to CMS whether their prescription drug coverage is creditable or non-creditable.  The disclosure is required on an annual basis within 60 days after the beginning of each plan year.  The CMS reporting is electronic.  (For more information, visit the CMS website.)



This Benefits Brief is not intended to be exhaustive nor should any discussion or opinions be construed as legal advice. Readers should contact legal counsel for legal advice.

Posted by in Blog, Health & Benefits, Human Resources

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