For Administrators and Employees
The Medicare Part D Creditable Coverage notice will inform Medicare-eligible individuals whether or not their insurance coverage provides creditable coverage for prescription benefits. This distinction is important for individuals who will be participating in the annual Medicare Part D Open Enrollment, which requires information about whether or not the enrollee has existing creditable prescription coverage.
Notices confirming whether or not coverage is creditable need to be provided to Medicare eligible individuals at the following times:
- Annually, prior to the Medicare Part D election period (October 15 through December 7),
- Within 3 months of attaining age 65,
- Prior to the effective date of coverage for any Medicare Part D eligible individual who enrolls in the Plan,
- Upon any change in creditable coverage status or termination of the plan, or
- Upon request by participants and beneficiaries.
The creditable coverage notice must be provided to:
- Medicare eligible active working individuals and their dependents,
- Medicare eligible COBRA individuals and their dependents,
- Medicare eligible disabled individuals covered under prescription drug plan, and
- Any retirees and their dependents.
Here are some examples of Creditable Coverage notices.
Medicare Part D CMS Disclosure
Entities that provide prescription drug coverage to Medicare Part D eligible individuals must disclose to Centers for Medicare and Medicaid Services (CMS) whether the coverage is “creditable prescription drug coverage.” These entities must use the online Disclosure to CMS Form.
Required entities must complete the disclosure:
- Annually no later than 60 days from the beginning of a plan year,
- Within 30 days after termination of a prescription drug plan, or
- Within 30 days after any change in creditable coverage status.
To access the online Disclosure to CMS Form, visit this page.
A downloadable guide with instructions, provided by CMS, is available on this page.
If you have any questions about the information on this page, please consult with your insurance broker.