Medicare Part D Creditable Coverage Disclosure to CMS


Each year, plan sponsors must disclose to the Centers for Medicare and Medicaid Services (CMS) the group health plan’s creditable coverage status for prescription drug coverage. This information is used to help CMS determine when there might be other coverage creditable available to individuals who are eligible for Medicare.

Who Has to Report

Any employer sponsoring a group health plan that provides prescription drug coverage is required to determine the plan’s creditable status and report to CMS. There really are not any exceptions, even for small employers. This reporting is typically not done by the insurance carrier or the third-party administration (TPA), but instead must by handled by the employer. Note that this reporting requirement is separate and distinct from the Medicare Secondary Payer reporting requirements under Section 111 that are due to CMS on a quarterly basis and typically handled the insurance carrier or TPA.

When to Report

This reporting is due within 60 days of the beginning of each new plan year.  For example, for calendar year plans, the due date will be March 1 (or February 29 if a leap year). In addition, disclosure must be made within 30 days after termination of the prescription drug plan, and within 30 days after any change to the creditable status of the prescription drug plan. This reporting is separate from the required Medicare Part D creditable/non- creditable coverage notice that is provided to participants upon initial eligibility and annually each year.

How to Report