Companies/entities offering prescription drug coverage to people eligible for Medicare Part D are required to disclose to the Centers for Medicare and Medicaid Services (CMS) whether their prescription drug coverage is considered ‘creditable’ or not. This disclosure must be made to CMS on an annual basis, or upon any change that affects whether the coverage is creditable. It is also required regardless of whether the coverage offered is primary or secondary to Medicare. See CMS’ document “Entities Required to Provide Disclose to All Medicare Eligible Individuals” for a list of who this requirement applies to. Companies that contract with Medicare directly as a Part D plan or that contract with a Part D plan to provide qualified prescription drug coverage are exempt from this disclosure requirement.
The Disclosure to CMS Guidance and Disclosure to CMS Form can be found on the CMS website at cms.hhs.gov/creditablecoverage.
Entities are also required to disclose information regarding creditable coverage to all Medicare beneficiaries who are covered by, or who apply for, prescription drug coverage under their plan. CMS provides model notices and language for companies to use, though they are not required. The Disclosure to CMS guidance and Disclosure to CMS form can be found on the CMS website. Disclosure of Creditable Coverage to Medicare Part D Eligible Individuals Guidance contains both sample notices and a list of the required elements a disclose notice must contain.
Basically entities are required to state:
- whether their coverage is considered ‘creditable,’
- a definition of creditable coverage,
- why creditable coverage is important for preventing any future premium penalty if the beneficiary chooses to enroll into a Medicare Part D plan at a future time, and
- an individual’s rights to receive and/or request a notice regarding creditable coverage.
For more information on creditable coverage, disclosure forms and guidance, visit the CMS website at cms.hhs.gov/creditablecoverage.
