Calendar Year Health Plans Must Complete Online CMS Disclosure by March 1st

For the past few years, health plan sponsors have been required to complete an annual online disclosure form with the Centers for Medicare and Medicaid Services (CMS), reflecting whether the prescription drug coverage offered under the sponsor’s plan(s) is “creditable” (at least as good as Medicare Part D’s prescription drug benefit) or “noncreditable” (not as good). The plan sponsor must complete the disclosure within 60 days after the beginning of the plan year if it has any employees or dependents eligible for and receiving Part D prescription drug benefits.

For calendar year health plans, the filing with CMS is due by March 1, 2017.

A CMS filing is also required within 30 days of termination of a prescription drug plan and for any change in a plan’s creditable coverage status. Some plans (described below) are exempt from the filing requirement.

Instructions related to the online filing discuss the types of information that are required, including the total number of Part D eligible individuals, the number of prescription drug options and which options are creditable and noncreditable. Click to access the instructions.

Click to access the online portal that is used to complete the submission.

The website suggests that the plan sponsor print a copy of the confirmation page for its records.

Plans Exempt from the Filing Process

Employer plans that do not offer drug coverage to any Medicare-enrolled employee, retiree or dependent at the beginning of the plan year are exempt from filing. Similarly, employers who qualified for the Medicare Part D retiree drug subsidy are exempt from filing with CMS, but only with respect to the individuals and plan options for which they claimed the subsidy. If an employer offers prescription drug coverage to any Medicare-enrolled retirees or dependents not claimed under the subsidy, the employer must complete an online disclosure for plan options covering such individuals.

Plan sponsors should complete the CMS filing to the best of their ability, even if they suspect (but are not sure) that their plan is exempt from doing so.

The Annual Part D Disclosure

Plan sponsors must at least annually issue to their Medicare-enrolled employees, retirees and dependents a notice apprising them that the drug coverage under the sponsors’ plans is creditable or noncreditable. Notices are required:

  • Prior to the annual Part D enrollment window, which opens each October 15th.
  • Prior to the individual’s personal “initial enrollment period” for Part D.
  • Prior to enrollment in the employer’s plan.
  • When the plan ceases to provide drug coverage, or the “creditable” nature of the drug coverage becomes “noncreditable,” or vice versa.
  • Upon request

We’ve long recommended that employers provide the Medicare Part D notice to employees by no later than October 15th of each year, and to any dependent(s) for whom you know is not residing with the employee. Because most employers are unaware of dependents’ eligibility for and enrollment in Medicare Part D we recommend providing the Part D annual notice to all employees, not just those over age 65.