Employer Action Required: Distribute Medicare Part D Notices by October 15, 2024

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This post is continually updated with the latest carrier information. Please be sure to check back for any additions.

Group health plan sponsors must provide Medicare Part D “creditable coverage” notices prior to October 15, the start date of the Medicare annual enrollment period for Part D, Prescription Drug coverage. Medicare Open Enrollment runs from October 15 to December 7, 2024.

Most plan sponsors use the Model Medicare Part D Notices provided by the Centers for Medicare and Medicaid Services (CMS) to notify plan participants. Links to all the model letters (in English and Spanish) are available here.

We are still waiting on some 2025 information from several carriers, which will be updated when received. Carrier plan listings and/or links to their creditable coverage sites are available below. Reminders will post weekly in the Monday Minute. Last year’s carrier credibility info is available below, which can be used to notify members of what will be in effect through the group’s next renewal.

Calendar year plans or plans renewing on January 1, 2025, should be tested against the 2025 Medicare Part D parameters. If the plan design subsequently changes prior to January 1, 2025, the plan should be re-tested to determine if there is a change in creditable coverage status. Any change in creditable coverage status should be disclosed to members.

Off-calendar year (2024 to 2025) plans should be tested against the 2024 Medicare Part D parameters. If the plan design subsequently changes for the 2025 to 2026 renewal/coverage period, the plan should be retested against the 2025 Medicare Part D parameters to determine if there is a change in creditable coverage status. Any change in creditable coverage status should be disclosed to members.

Aetna

Reach out to your broker advisor for specific plan information.

Allstate

2025 coming soon

Anthem IN

Links below illustrate non-creditable plans only with all other plans not listed deemed to be Creditable.

Anthem KY

Links below illustrate non-creditable plans only with all other plans not listed deemed to be Creditable.

Anthem OH

The Christ Hospital Plan (administered by Key Benefit Administrators)

  • 2024
    • All standard level-funded plans are creditable.
    • For custom self-funded groups, account representatives will review the group and determine if the pharmacy benefit is creditable.
  • 2025 coming soon

Direct Health Connect

  • 2024
    • Most Funding Advantage plans are Medicare D creditable
      • Those that are not are those with a $5,000 deductible or higher paired with a deductible integrated Rx plan.
    • Cost Saver Plans (1, 2, 3) are not creditable.
    • All standard formulary plans are creditable.
  • 2025 coming soon

Medical Mutual

Medical Mutual tested all our commercial group health plans that have prescription drug coverage, and the vast majority were deemed to be creditable for 2025.

All 2 to 50 small groups, 51 to 99 groups, MEWAs, and Grandfathered and Grandmothered plans were deemed to have creditable prescription drug coverage. Below is the flyer for reference.

There are two small group plans that were deemed non-creditable: the SILVER 5030-7000 PD MEDFLEX plan and the COSE BP SMP 9200 MMRX plan.

SummaCare

Trustmark

UnitedHealthcare

Frequently Asked Questions

The October 15th deadline applies for all group health plan sponsors, regardless of plan year, plan size, employer size, grandfather status, or whether the plan is insured or self-funded.

Employers who send out Open Enrollment packets prior to October 15th often include the Medicare Part D notices in the Open Enrollment packets, to avoid the extra cost and administrative burden of sending them separately.

Employers are also required to notify CMS online annually that they have sent out these Part D notices. The notice to CMS is due within 60 days after the start of the plan year. See the last paragraph of this article for details.

When Is the Medicare Part D Notice Required?

Medicare Part D notices must be provided at least once annually, prior to October 15th, which is the beginning of the Part D annual enrollment period. Additional notices must be provided if the employer-provided coverage changes (from creditable to non-creditable, or vice-versa), if the individual requests a copy of the notice, and when an individual first enrolls in the employer plan.

Why is the Part D Notice Required?

The reason plan sponsors are required to provide Part D Notices is because a penalty will be imposed on an individual if he/she, after becoming eligible for Medicare Part D coverage, has a lapse of “creditable” prescription drug coverage for a period of at least 63 days. Additionally, such individuals may have to wait until the following October to join. An individual can elect either Medicare prescription drug coverage or other “creditable coverage” to avoid having a lapse in coverage. Thus, Medicare-eligible participants in employer group health plans must know whether or not the employer group coverage is “creditable” so they do not unwittingly incur a late enrollment penalty.

Additional Details on the Disclosure Requirements

  • Group health plan sponsors to whom this disclosure requirement applies include employers and Unions; multiple employer welfare arrangements (MEWAs); federal, state and local government employers; and churches.
  • The Part D Notice must be provided not only to Medicare-eligible active working employees and their dependents, but also to participants who are retired, on COBRA, or disabled and covered under the employer’s prescription drug plan.
  • Although the requirement is only that “Medicare-eligible” individuals be provided this notice, employers often provide it to all plan participants and dependents, because of the practical difficulty of knowing who is Medicare-eligible.

Annual Notice to CMS Also required, though not by October 15th

Additionally, plan sponsors are required to notify CMS annually, via the CMS website (Online Disclosure to CMS form). This notice must be made within 60 days after the beginning of the plan year (or contract renewal date, for small plans that do not file Form 5500s so do not specify a plan year), and it pertains to the creditable coverage status for the prior plan year. For calendar year plans, this notice must be provided to CMS no later than March 1.  Sponsors of non-calendar year plans should mark their calendars to make sure the disclosure to CMS is made within 60 days after the beginning of the plan year (e.g., for an April 1 plan year, the CMS online disclosure should be made no later than May 30).

Additionally, if applicable, plan sponsors must complete the Online Disclosure to CMS Form within 30 days after termination of a prescription drug plan or within 30 days after any change in creditable coverage status.

For additional information, click here for the main CMS webpage that provides guidance on “creditable coverage.” Or you can visit the webpage  at https://www.cms.gov/Medicare/Prescription-Drug-Coverage/CreditableCoverage/)

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