Employers sponsoring group health plans that provide prescription drug coverage to individuals eligible for Medicare Part D coverage[1] must annually disclose to the Centers for Medicare and Medicaid Services (CMS) whether that coverage is considered creditable or non-creditable. To be considered creditable, the plan’s drug coverage must be at least actuarially equivalent to Medicare Part D prescription drug coverage.
This reporting requirement[2] applies to both self-funded and fully insured group health plans and also applies whether the prescription drug coverage is primary or secondary to Medicare.
This annual disclosure must be provided to CMS within 60 days of the start of the plan year.
For employers with calendar year plans (January 1 – December 31, 2023), the deadline to complete this disclosure reporting to CMS is Thursday, February 29, 2024 (typically March 1 each year; since 2024 is a leap year, the deadline is February 29, 2024).
Employers must also complete disclosure reporting to CMS within 30 days following either:
To complete this CMS disclosure online, click here. For additional CMS guidance and instructions on this reporting requirement, click here.
CMS’s Creditable Coverage webpage can be accessed here.
CMS Disclosure Form Required Data Fields Include:
Please note that this annual disclosure reporting to CMS is different from the requirement to provide Part D-eligible individuals with a notice disclosing the creditable status of the plan’s prescription drug coverage before October 15 of each year. Click here for more details on determining whether a group health plan’s prescription drug coverage is considered creditable or non-creditable.
Employers with calendar year plans (January 1 – December 31, 2023) are advised to take action now and complete the online disclosure reporting to CMS by the deadline of Thursday, February 29, 2024.
Reach out to your Risk Strategies team members with any questions or contact us directly at benefits@risk-strategies.com.
[1] Includes Medicare-eligible employees, retirees, spouses, or dependents.
[2] Group health plans that do not provide prescription drug coverage to any Medicare Part D eligible individuals as of the beginning of the plan year are not subject to this CMS reporting requirement for that plan year.