Medicare Part D - Disclosure to CMS

Medicare Part D Disclosure Notice to CMS

To download this whole document as a PDF, click here: Medicare Part D Disclosure to CMS

Medicare Part D imposes disclosure requirements on employers whose health plans provide prescription drug coverage to Medicare-eligible individuals. Group health plans—or entities that offer prescription drug coverage on a group basis to active and retired employees and to Medicare Part D eligible individuals—must provide, or arrange for providing, a notice of creditable prescription drug coverage to those Medicare Part D eligible individuals who are covered by, or who apply for, prescription drug coverage under the health plan.

In addition, group health plan sponsors are required to complete an online disclosure form with the Centers for Medicare & Medicaid Services (CMS) on an annual basis and at other select times, indicating whether the plan’s prescription drug coverage is creditable or non-creditable. This disclosure is required whether the health plan’s coverage is primary or secondary to Medicare.

Disclosure to CMS

Group health plan sponsors are required to disclose to CMS whether their prescription drug coverage is creditable or non-creditable. In general, a group health plan’s prescription drug coverage is considered creditable if its actuarial value equals or exceeds the actuarial value of the Medicare Part D prescription drug coverage. The determination of creditable coverage does not require an attestation by a qualified actuary, except when the plan sponsor is electing the Retiree Drug Subsidy for the group health plan.

The disclosure must be made to CMS on an annual basis, and upon any change that affects whether the coverage is creditable.

The disclosure to CMS must be made within these timeframes:

  • Within 60 days after the beginning date of the plan year for which the entity is providing the disclosure to CMS;
  • Within 30 days after the termination of a plan’s prescription drug coverage; and
  • Within 30 days after any change in the plan’s creditable coverage status.

Plan sponsors are required to use the online disclosure form found on the CMS Creditable Coverage webpage at https://www.cms.gov/Medicare/Prescription-Drug-coverage/CreditableCoverage/CCDisclosureForm.html.  This is the sole method for compliance with the disclosure requirement, unless the entity does not have Internet access. The disclosure form lists required data fields that must be completed in order to generate the disclosure notice to CMS such as creditable coverage status, plan year, number of Part D eligible individuals covered, date the creditable coverage disclosure notice is provided to Part D eligible individuals, and change in creditable coverage status.

more information

Additional information about this disclosure requirement and about creditable coverage in general is available on the CMS Creditable Coverage webpage at: www.cms.hhs.gov/CreditableCoverage.