Medicare Part D Creditable Coverage Certificates to Employees

It is that time of the year again when the annual Notice of Creditable Coverage as required under Medicare Part D must be distributed by Employers. The notice informs participants if the prescription drug coverage offered under the Employer's group health plan is considered "creditable" or "non-creditable" coverage. Employers who sponsor a health plan that includes prescription drug benefits must provide the annual notice to all Medicare-eligible participants. The notice will explain whether or not the prescription drug benefits offered under the group health plan are at least as good as the benefits offered under the Medicare Part D plan. The Notice of Credible Coverage must be provided: At least once a year before October 15th (the start of the annual Medicare Part D enrollment period which is from October 15th through December 7th for 2019). Whenever a Medicare-eligible employee, spouse or dependent enrolls in the employer's health plan (including Medicare eligible COBRA individuals and their dependents; Medicare eligible disabled individuals covered under the group health plan's prescription drug plan and any retirees and their dependents). Whenever there is a change in the creditable or non-creditable status of the employer's health plan prescription drug coverage. Whenever an individual requests the notice. CMS (The Centers for Medicare and Medicaid Services) has posted forms and instructions for providing this notice. Forms are available in English and Spanish. To access more information on this subject, please click on the link below: https://www.cms.gov/CreditableCoverage/ To access the notices, please click on the link below: https://www.cms.gov/Medicare/Prescription-Drug-Coverage/CreditableCoverage/CCDisclosureForm.html

Important Note for Employers! Employers must provide a disclosure to CMS on an annual basis, via an online form, reporting whether their prescription drug coverage is creditable or non-creditable. CMS requires that the disclosure be provided within: 60 days after the beginning date of the Plan Year for which the entity is providing the Disclosure to CMS Form; 30 days after the termination of the prescription drug plan; and 30 days after any change in the creditable coverage status of the prescription drug plan. Information regarding the Employer's Disclosure to CMS can be found by clicking on the link below: https://www.cms.gov/medicare/prescription-drug-coverage/creditablecoverage/ccdisclosureform.html

NEVERMIND, YOU CAN KEEP YOUR PLAN.....ATLEAST FOR INDIVIDUALS

Today in a statement from the President, individual policyholders will now be allowed to maintain their current health plan if they so choose.  This was on the heels of tremendous pressure put on the President because of statements made by him....."if you like your health plan, you can keep your health plan, period".  As we all know this turned out to be untrue.  What seems to be overlooked are all of the individuals and families in employer based coverage being forced into reform plans. (Employer Group Under 50 Employees)  If employer based plans are not "Grandfathered" same as individual market, they would lose their current plan and be forced into a plan that now conforms to the Affordable Care Act (health reform).  The individual market is being addressed, the small group employer market is being overlooked.  

POSSIBLE DELAYS TO THE INDIVIDUAL MANDATE UNDER TRANSITION RELIEF

According to IRS Notice 2013-42, for non-calendar year Medical Plans, transition relief is available for those plans that begin in 2013 and end in 2014.  If your coverage is available through an employer, depending upon when that coverage is made available to you (or your spouse) would depend upon when you would need to obtain coverage.

Example 1. You are eligible for enrollment in a non-calendar year employer sponsored medical plan beginning August 1, 2013 and ending July 31, 2014.  You have parent/child coverage for you and your 10-year old son.  You do not elect coverage for yourself/son on August 1, 2013.  Under this rule you would have transition relief through July 31, 2014.  If you do not elect coverage at this time, penalties would be assessed.

Example 2. You are Married and both you and your spouse are eligible for enrollment in a Non-Calendar Year Plan of an Employer for the 2013-2014 Plan Year and in a Calendar Year Plan with your Spouse’s Employer for 2014.  Your plan begins August 1, 2013 and ends July 31, 2014.  Your spouses plan begins January 1, 2014.  You do not elect coverage for you and your spouse under your plan August 1, 2013 and your spouse does not elect coverage for the both of you on January 1, 2014. In this example both you and your spouse would have transition relief until your plan renewal in August of 2014.  If at this time, no coverage was elected, penalties would be assessed.

(From IRS Notice 2013-42)