If your group health plan includes prescription drug coverage for anyone eligible for Medicare Part D, you must file an online disclosure with Centers for Medicare & Medicaid Services (CMS) each year and at certain other times, stating whether your coverage is creditable or non-creditable. This filing is due within 60 days of the start of your plan year, by March 1, 2026, for calendar-year plans.
At the start of each plan year, confirm whether your group health plan covers any Medicare-eligible individuals. If CMS reporting applies, work with your advisors to determine if your prescription drug coverage is creditable or non-creditable and submit the required online disclosure form using CMS’ Creditable Coverage website and instructions.
Group health plan sponsors must report to CMS whether their prescription drug coverage is creditable (as good as or better than Medicare Part D) or non-creditable, even if the plan is secondary to Medicare. This status is based on whether the plan’s expected paid claims meet or exceed Medicare Part D’s value.
Insurers may provide this determination for insured plans. If not, employers may be able to use a simplified method, depending on plan design; otherwise, a full actuarial analysis is required. Keep in mind that the Inflation Reduction Act’s prescription drug cost provisions may affect this calculation.
Compliance Tip: If your group health plan does not offer prescription drug coverage to any Medicare Part D–eligible individuals (including active/disabled employees, COBRA participants, retirees, and their covered spouses/dependents) at the start of the plan year, you do not have to file the CMS disclosure for that year.
You must report your plan’s Part D creditable coverage status to CMS each year and whenever that status changes. Specifically, you must disclose: within 60 days of the start of each plan year, within 30 days after ending prescription drug coverage, and within 30 days after any change in creditable coverage status.
Plan sponsors must complete CMS’ online creditable coverage disclosure form, CMS’ only accepted method unless the entity has no internet access. The form requires key details (coverage types and options, creditable or non-creditable status, disclosure period, number of Part D-eligible individuals covered, date notices are provided, and any status changes). CMS also offers instructions that define each field and guide you through submission.
In addition to the annual CMS disclosure, group health plan sponsors must also notify Medicare Part D–eligible individuals whether the plan’s prescription drug coverage is creditable. These notices must be provided at the following key times:
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Prior to the Medicare Part D annual coordinated election period, beginning Oct. 15 through Dec. 7 of each year
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Prior to an individual's initial enrollment period for Part D
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Prior to the effective date of coverage for any Medicare-eligible individual who joins the plan
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Whenever prescription drug coverage ends or changes so that it is no longer creditable or becomes creditable |
Upon a beneficiary's request
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To meet Medicare Part D requirements, simply send the creditable coverage disclosure notice to all plan participants once every 12 months, before October 15. It’s also recommended to include this notice in new hire enrollment materials. CMS offers model notices you can easily download and use from its website. Download the bulletin for more details.