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Since 2006, Medicare beneficiaries have been eligible to receive prescription drug coverage through Medicare’s Part D program, enacted as part of the Medicare Modernization Act of 2003 (MMA). Group health plans and individual health insurance policies that offer prescription drug coverage to Medicare-eligible individuals must comply with the following notice requirements:

• Disclosure Notice to the Centers for Medicare & Medicaid Services (CMS)

Disclosure must be completed annually, within 60 days following the start of the plan year, via the CMS website, www.cms.gov. Please note that this is the sole method for compliance with this CMS disclosure requirement.

• Disclosure Notice to Medicare Part D Eligible Individuals

In addition to the CMS notification, the plan sponsor must notify individuals eligible who participate in their medical plan whether their plan’s prescription drug coverage is “creditable” or “non-creditable” compared to Medicare Part D coverage. Again, for the basic steps to determine if an employer’s plan is creditable, the CMS has provided guidance entitled “Creditable Coverage Simplified Determination” that may be reviewed at:

http://www.cms.gov/CreditableCoverage/Downloads/CCSimplified091809.pdf.

This notice must be provided to Medicare Part D eligible individuals:

  • On an annual basis, prior to Oct. 15, which is the start of the Medicare Enrollment Period;
  • When the individual originally becomes eligible under the group plan;
  • Upon a change in the plan’s creditable coverage status;
  • Upon termination of the plan’s prescription drug benefit; and
  • Upon an individual’s request.

An individual becomes eligible for Medicare due to age, end-stage renal disease or disability. Additionally, an employee’s spouse or dependent may be eligible for Medicare. Therefore, it might be difficult for an employer to identify individuals who are eligible for Medicare. It is therefore recommended that the notice be distributed to all employees who are eligible to participate in the employer’s plan.