HC1 Medicare Creditable Coverage Notification

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Medicare Part D

Notification Requirements for Creditable Coverage

On January 1, 2006 the Centers for Medicare and Medicaid Services (CMS) introduced Medicare Part D which offers prescription drug coverage to all Medicare beneficiaries. With the new program, Medicare-eligible enrollees were urged to participate in the standard Medicare Part D or another “creditable” prescription drug plan to avoid late enrollment fees.

Coverage is defined as “creditable” when its actuarial value equals or exceeds the standard Medicare Part D prescription drug benefit. In general, the actuarial value of the benefit is determined by whether or not the prescription drug coverage is expected to pay out on average at least as much as the standard Medicare Part D coverage would pay in a calendar year. If the coverage does not equal or exceed the value of the standard Medicare Part D benefit, it is considered “non-creditable”.

Employers are required to disclose the creditable status of their pharmacy plans to Medicare eligible enrollees (active employees and retirees) by October 15 of each year. All medical plans include pharmacy coverage so it is necessary for you to distribute notices to each of your employees and/or retirees enrolled in a medical plan, indicating whether the plan they have is “creditable” or “non-creditable."

Creditable Coverage Notices

CMS requires the distribution of a Creditable Coverage notice annually, no later than October 15. We recommend you distribute a copy of the Creditable Coverage Notice to all employees and retirees enrolled in a ConnectiCare ACA-compliant medical plan offered by your company. For more information, visit the CMS website.