Medicare Part D Advisory: Sponsors of Prescription Drug Plans Must Provide Notices Prior to October 15 Each Year

Sponsors of group health plans that cover prescription drugs must provide Medicare Part D creditable (or non-creditable) coverage notices prior to October 15, the start date of the Medicare annual enrollment period for Part D, Prescription Drug coverage.

The enrollment period is October 15 – December 7. Most plan sponsors customize the Model Medicare Part D Notices provided by the Centers for Medicare and Medicaid Services (CMS) to notify affected plan participants. The October 15 deadline applies for all group health plan sponsors that offer prescription drug benefits, regardless of plan year, plan size, employer size, grandfather status, or whether the plan is insured or self-funded.

The purpose of the disclosure is to inform Medicare beneficiaries of whether the employer’s drug coverage is expected to provide coverage comparable to the Medicare Part D prescription drug coverage. Medicare-eligible employees should keep the creditable coverage notice for future reference.

If a Medicare-eligible employee or dependent becomes eligible for Part D and decides not to enroll because he or she has employer-sponsored coverage, a creditable coverage notice allows them to enroll in Part D later without being charged a higher premium. For individuals enrolled in a non-creditable drug plan, failure to enroll in Part D when first eligible will result in higher premium if they enroll in Part D later.

The Notice of Creditable (or Non-Creditable) Coverage must be distributed to all individuals enrolled in an employer’s group health plan that fall within one of the following categories:

  1. Active employees or COBRA participants over age 65 eligible for Medicare (Part A and/or B)
  2. Spouses of active employees over age 65 eligible for Medicare (Part A and/or B)
  3. Dependent children of active employees eligible for Medicare (Part A and/or B) regardless of age
  4. Retirees over age 65 eligible for Medicare (Part A and/or B)
  5. Spouses of active employees and/or retirees eligible for Medicare Part A and/or B
  6. Dependent children of a retiree eligible for Medicare (Part A and/or B) regardless of age

Because employers typically do not know if a dependent is eligible for Medicare due to disability or end-stage renal disease, Bolton recommends providing the notice to all covered employees.

An employer is only required to provide one Notice of Creditable Coverage per household even if more than one member of the household is covered by the group health plan and eligible for Medicare.

Electronic Distribution

Employers can distribute these notices electronically to participants who have the ability to access electronic documents at their regular place of work as long as those participants have access to the electronic information system on a daily basis as part of their work duties. Employers can distribute electronically under these circumstances without the participant’s consent. Participants must be informed, however, that they are responsible for providing a copy of the electronic notice to their Medicare-eligible dependents covered under the group health plan.

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.

Visit this link to the CMS page regarding Creditable Coverage. From this page, you can find links to model notices (on the left) and other guidance. The models can be easily customized for your employees.

Other resources to answer your questions can be found at


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About John Garner

John Garner has over thirty five years of experience in employee benefits. He specializes in compliance, health care reform, the Health Insurance Portability and Accountability Act (HIPAA), the Consolidated Omnibus Budget Reconciliation Act (COBRA), and the Employee Retirement Income Security Act (ERISA). He helps clients with life, health, and disability benefits, cost containment, flexible benefits, and claim consulting.

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