Creditable Coverage Disclosure to CMS for Calendar Year Plans due March 1, 2025

Group health plan sponsors offering prescription drug coverage are required to annually disclose to the Centers for Medicare & Medicaid Services (“CMS”) whether their coverage is “creditable” or “non-creditable.” For calendar year plans starting on January 1, 2025, this disclosure must be completed by March 1, 2025.

Understanding Creditable Coverage

“Creditable” prescription drug coverage means that the plan’s coverage is at least as good as the standard Medicare Part D prescription drug coverage. This determination is crucial because Medicare-eligible individuals who do not enroll in a Part D plan when first eligible may face a late enrollment penalty if they go 63 consecutive days or more without creditable prescription drug coverage.

Disclosure Requirements

Plan sponsors must disclose their plan’s creditable or non-creditable status to CMS using the online Disclosure to CMS Form. This disclosure is required:

1. Within 60 days after the beginning of the plan year.
2. Within 30 days after any change in the plan’s creditable coverage status.
3. Within 30 days after the termination of the prescription drug plan.

For calendar year plans beginning on January 1, 2025, the deadline for the annual disclosure is March 1, 2025.

Steps to Complete the Disclosure

1. Access the Online Form: Visit the CMS website and locate the Disclosure to CMS Form under the “Related Links Inside CMS” section.
2. Complete the Form: Provide the necessary information about your organization’s prescription drug plan, including whether the coverage is creditable or non-creditable.
3. Submit the Form: Ensure that the form is submitted electronically by the applicable deadline.

It’s important to note that this disclosure requirement applies to all plan sponsors that provide prescription drug coverage to Medicare Part D eligible individuals, regardless of whether the coverage is primary or secondary to Medicare.

Additional Considerations

In addition to the CMS disclosure, plan sponsors are also required to provide a written notice to all Medicare-eligible individuals who are covered under or apply for the prescription drug plan. This notice must be provided annually before October 15th and upon certain other events, such as before an individual’s initial enrollment period for Part D.

Failure to comply with these disclosure requirements can result in penalties and may affect individuals’ decisions regarding their Medicare Part D enrollment. Therefore, it’s essential for plan sponsors to adhere to these requirements and deadlines.

For more detailed guidance and instructions on completing the disclosure, please refer to the CMS website.

Additional Resources

• Medicare Part D Creditable Coverage Disclosure to CMS
• What Employers Need to Know about Medicare Part D Notices
• CMS Website
• Disclosure to CMS Form
• Overview of Creditable Coverage Issues for Plan Sponsors (PDF)
• What is Creditable Coverage (PDF)
• Entities Required to Provide Disclosure (PDF)