MEDICARE PRESCRIPTION DRUG ACT

MEDICARE PRESCRIPTION DRUG IMPROVEMENT AND MODERNIZATION ACT

 

The initial enrollment period for Medicare eligible beneficiaries to enroll in Medicare Part D has passed, all employers must continue to fulfill annual requirements with both their employees and Centers for Medicare and Medicaid Services (CMS).

 

Group health plans must provide notice to Medicare-eligible participants advising whether prescription drug coverage provided under the plan is “creditable” or “non-creditable” at the following times:

  • Prior to the Medicare Part D Annual Coordinated Election Period (ACEP) beginning October 15- December 7 of each year (this deadline previously was November 15).
  • Prior to an individual’s Initial Enrollment Period (IEP) for Part D, as described under 423.38(a).
  • Prior to the effective date of coverage for any Medicare-eligible individual that joins the plan.
  • Whenever the entity no longer offers prescription drug coverage or changes the coverage offered so that it is no longer creditable or becomes creditable.
  • Upon a beneficiary’s request.

 

A prescription plan is deemed creditable if it is expected to pay out as much as the standard Medicare prescription drug coverage will pay in 2011. If your company’s creditable coverage is on average at least as good as standard Medicare prescription drug coverage, Medicare eligible employees can keep this coverage and not pay extra if they later decide to enroll in Medicare coverage.

 

Employers must also provide a disclosure of creditable coverage status to CMS. An entity is required to provide the Disclosure Notice through completion of the disclosure form on the CMS Creditable Coverage Disclosure Web Page. 

 

At a minimum, disclosure to CMS must be made at the following times:

  • Within 60 days after the beginning date of the plan year for which the entity is providing the disclosure to CMS.
  • Within 30 days after the termination of the prescription drug plan.
  • Within 30 days after any change in the creditable coverage status of the prescription drug plan

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