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Medicare Part D Creditable Coverage Disclosure Due to CMS

 February 24 2017     Diane Cross

As a reminder, there are two disclosures required annually for certain employers related to Medicare Part D.  Employers with group health plans that provide prescription drug coverage to individuals that are eligible for Medicare Part D must disclose whether their drug benefit is creditable coverage to (1) individuals eligible for Medicare Part D and (2) to the Centers for Medicare & Medicaid Services (CMS).  The disclosure to CMS is due by March 1st for calendar-year plans.  

At a minimum, disclosure to CMS must be made at the following times: 

  • Within 60 days after the beginning of the plan year
  • Within 30 days after the termination of the prescription drug coverage
  • Within 30 days after any change in the creditable coverage status of the prescription drug plan

There are a few exceptions to the employer’s requirement to disclose Medicare D status to CMS, such as:

  • Employers not offering prescription benefits to any Medicare D eligible individuals on the beginning date of the plan year are not required to complete a disclosure to CMS form for that plan year.
  • Employers and unions that have applied and been approved for the Retiree Drug Subsidy (RDS) are exempt from filing the form. The exemption applies only to the covered members and plan options for which the employer is claiming the RDS. The plan sponsor’s RDS application will serve as disclosure to CMS.

Employers must provide the following Information on the disclosure to CMS:

  • Name of Entity
  • Federal Tax Identification Number (EIN)
  • Entity geographical information
  • Phone number of entity
  • Type of coverage
  • Creditable coverage status
  • Identify “authorized individual” of the entity

Disclosure must be made online via form CMS-10198. Further guidance and instructions for disclosure may be found at CMS Creditable Coverage. Online submission is the sole method for disclosure.

Please contact your HORAN account representative with additional questions.