Creditable Coverage Determination
Prescription drug coverage is "creditable" if it is at least as good as Medicare Part D standard coverage. The determination is made using an actuarial equivalence test. Most employer-sponsored prescription drug plans are creditable — but the determination must be made annually and documented.
Notice Requirements
- Provide notice to all Medicare-eligible participants and dependents before October 15
- Provide notice at initial enrollment
- Provide notice when prescription drug coverage changes
- Provide notice when the plan no longer offers prescription drug coverage
- Report creditable coverage status to CMS within 60 days of the plan year start
CMS Reporting
Compliance Note
Plans must report creditable coverage status to CMS annually through the CMS Creditable Coverage Disclosure to CMS online form. The report must be submitted within 60 days of the start of the plan year, within 30 days of termination of prescription drug coverage, and within 30 days of any change in creditable coverage status. Confirm your TPA or carrier is submitting this report on your behalf.