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Medicare Part D Notification Requirements

Medicare Part D is a voluntary prescription drug benefit. There are two notification requirements tied to this benefit: One to Centers for Medicaid and Medicare Services (CMS) and one to individuals. Individuals are required to pay a premium penalty for each month they are not enrolled in Medicare Part D, but they will not be penalized if they are enrolled in a creditable prescription drug plan. For this reason, these Medicare Part D notice requirements are vital.

To whom does this apply?

This applies to group health plans that offer prescription drug benefits to Medicare Part D–eligible individuals (with eligibility based on attaining age 65 or being disabled prior to age 65).

 

This includes:

  • Plans offered by employers.

  • Union/Taft-Hartley plans.

  • Church and governmental plans.

  • Plans that provide coverage of prescription drugs to veterans.

  • Plans that provide military coverage (including TRICARE).

  • Coverage provided by tribal organizations.

  • Qualified retiree prescription drug plans.

  • Plans that offer coverage under a Medicare supplemental policy.


Notice to CMSNotice to Individuals
When must the certification be sent?

The annual CMS notice must be given online, at the CMS website, within:

  • 60 days after the first day of the plan year, making March 1 the deadline for calendar year plans only.
  • 30 days after the termination of a prescription drug plan and/or 30 days after any change in the creditable coverage status of a prescription drug plan.

Plans must also notify Medicare Part D–eligible individuals* of the status of their prescription drug coverage at a minimum as follows:

  • Prior to the individual’s initial period of entitlement for Medicare Part D
  • Prior to the effective date of the individual's enrollment in the employer's prescription drug plan
  • Upon any change in the employer's prescription drug coverage as creditable or non-creditable
  • Annually, on or before October 15 of each year
  • Upon an individual's request.
What information must the certification contain?

Plan sponsors should have the following information available when completing the online certification to CMS:

  • The number of prescription drug options they offer to Medicare-eligible individuals. For example, a plan sponsor with an HMO, a PPO and an indemnity option available under its plan would identify three prescription drug options.
  • The number of benefit options offered that are considered creditable coverage and the number that are considered non-creditable.
  • An estimate of the total number of Part D–eligible individuals expected to have coverage under the plan at the start of the plan year, including active employees,
    retirees, disabled individuals and any of their Part D–eligible dependents, and any individuals on COBRA who are Part D–eligible.
  • The most recent calendar date on which the required notices of creditable or non-creditable coverage were provided.
For the individual notice, sample notices and guidance can be found on the CMS website

*Technically, this notice must be provided only to covered individuals entitled to Medicare Part D; though most employers provide it to all individuals covered by the plan. This is because it is impractical (and often impossible) for employers to know which individuals covered by their plan are entitled to Medicare Part D. CMS has indicated that a single notice may be provided to one household, unless it is known that any spouse or dependent resides at a different address than the employee.

 

What will Meritain Health do to assist with this requirement?

If Scrip World is your PBM vendor, you may request that Scrip World perform the simplified test as described by the
Centers for Medicare & Medicaid Services. Once the test is complete, Scrip World will notify you if your coverage is creditable or non-creditable. Please contact your Meritain Health client relationship manager to request this test. If a plan was creditable last year and the plan did not change its plan design since its last renewal, it can rely on the analysis performed last year to make this year's decision. We do not perform this test for groups who do not use Scrip World as their PBM vendor.

 

Employers should confirm they have marked their calendars accordingly, based on the above deadlines, to ensure they satisfy their Medicare Part D notification requirements.

 

 

You can obtain sample model notices from CMS here.

 

If you have questions, please contact your Meritain Health representative or client relationship manager.

 

This content is being provided as an informational tool. It is believed to be accurate at the time of posting and is subject to change. It is recommended that plans consult with their own experts or counsel to review all applicable federal and state legal requirements that may apply to their group health plan. By providing this information, Meritain Health is not exercising discretionary authority or assuming a plan fiduciary role, nor is Meritain Health providing legal advice.