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 as generous as Medicare Part D prescription drug coverage. Click here for a Risk Strategies article with more information on determining the creditable coverage status of a plan’s prescription drug benefit.
This disclosure reporting requirement[2] applies to self-funded, level-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, which is typically March 1 (or February 29 for leap years).
For employers with calendar year group health plans (January 1, 2026 – December 31, 2026), the upcoming deadline to complete this disclosure reporting to CMS is March 1, 2026.
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 detailed instructions on this reporting requirement, click here.
CMS's webpage on Creditable Coverage can be accessed here.
Online reporting is the sole method for compliance with the disclosure requirement, unless an employer sponsoring a group health plan does not have internet access.
CMS Disclosure Form Required Data Fields Include:
Practical Tip: For an entity with subsidiaries/divisions, one disclosure form can be submitted to CMS if the plan year is the same for all subsidiaries/divisions. If all subsidiaries/divisions of the entity are covered under the same type of coverage, use the parent company's EIN.
Practical Tip: CMS guidance directs employers to estimate how many Part D-eligible individuals they expect to be covered as of the first day of the plan year, excluding any applicable Retiree Drug Subsidy participants. Employers should work with their plan vendors (including insurance carriers, third-party administrators, pharmacy benefits managers, etc.) to verify whether the prescription drug plans offered cover any Medicare-eligible individuals (including active, retired, disabled individuals, their dependents, or individuals on COBRA) at the start of each plan year.
Individuals who will not become eligible until sometime during the year should not be included for that year (they should be included in the notice for the next plan year).
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 by October 15 of each year (coinciding with the annual Medicare Part D enrollment period).
Click here for more details on the October 15 notice distribution deadline and also how to determine a group health plan’s prescription drug coverage creditable status for the 2026 calendar year.
Employers with calendar year plans are advised to take action now and complete the online disclosure reporting to CMS by the deadline of March 1, 2026.
Contact your Risk Strategies team members for further assistance, or contact us directly here.
[1] Includes active, retired, and disabled employees, their covered dependents, and individuals on COBRA.
[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.