- Posted by Scott Wham
- On December 16, 2016
Employer-sponsored health plans that offer any type of prescription drug coverage to employees or dependents eligible for Medicare Part D coverage have an annual obligation to inform both the Centers for Medicare and Medicaid Services (CMS) and all Medicare-eligible plan participants if the coverage offered is as generous as the standard Part D drug plan (“creditable”) or not. As we get ready to usher in 2017, here at Kistler Tiffany Benefits we want to make sure all of our clients are aware of the Medicare Part D disclosure rules. To make sure that your plan meets its annual compliance obligations, we have prepared this checklist for you to follow.
- As you determine your benefit plan offerings for the year ahead, work with your KTB Consultant to determine if the prescription drug coverage your plan offers to employees is “creditable.” In most cases, you will be able to apply a simple test to determine the status of all prescription drug offerings included as part of your plan.
- Determine if your plan will offer prescription drug coverage, creditable or not, to anyone who could be Medicare-eligible, including dependents. These individuals do not need to be enrolled in Medicare Part D, but merely eligible to obtain Part D coverage if they choose. If you do not offer prescription drug benefits to any Medicare Part D eligible individuals as of the beginning of the plan year, then the plan is not required to submit the online disclosure form to CMS for the plan year.
- If your plan will or could offer any type of prescription drug coverage to any Medicare Part D eligible individual, set up a calendar reminder for a week after your new plan year begins to go to the CMS website and complete the online disclosure process. This will keep your compliant with the requirement that the plan submit its online disclosure information to CMS within 60 days of the start of the plan year. For calendar year plans, the deadline is by March 1, but for plans that renew mid-year the due date for CMS disclosure will vary. The online form is fairly straightforward, but help is available online too including detailed guidance, instructions, and sample screen shots to use as a sample.
- Review the model notices provided by CMS and adapt them to include information specific to your plan.
- Set a calendar reminder to notify all Medicare Part D eligible individuals offered prescription coverage under the plan about the status of every type of prescription drug covered included in the group plan before October 15 (“before” is defined by CMS guidance as within the past 12 months). Notices do not need to be mailed in most cases. They can be provided as part of plan open enrollment materials as long as the notice is separate and prominently labeled. Also, one notice can be provided to an employee and will serve as sufficient for all Medicare-eligible dependents unless the plan sponsor has knowledge that the Medicare-eligible dependent lives at a separate address. Notice can be provided electronically as long as the employee has the ability to access electronically distributed or posted information at work. Important note: While Part D disclosure only needs to be made to plan participants who are eligible for Medicare Part D coverage, given the difficulty of determining the Medicare-eligibility status of dependents, many employer plans simply include their Part D creditable coverage notice as part of their open enrollment materials provided to all eligible employees and dependents.
- As a best practice, include an updated version of your plan disclosure notice in the enrollment packet your company provides to all employees and dependents being offered coverage for the first time.
- Always keep an updated copy of your plan’s disclosure notice available and easily accessible, so that if a beneficiary requests an additional copy at any time, it can be provided.
- If you change or eliminate prescription drug benefits offered under the plan for any reason, keep in mind that you will need to provide timely notification about the plan change or termination to both all potential Part-D eligible beneficiaries and CMS.
We have also prepared a chart detailing the specific requirements plan sponsors need to follow concerning Medicare Part D disclosures to both CMS and plan participants.