Medicare Part D Assistance

Creditable Coverage Notice Requirement

Under the Medicare Modernization Act of 2003, you are required by the Centers for Medicare and Medicaid Services (CMS) to notify your Medicare eligible employees and retirees, their spouses and dependents annually of the creditable coverage status of your prescription drug plan ( s ) . To assist you, MIIA has included a SAMPLE Creditable Coverage Disclosure Notice below.

This Notice should be provided to all Medicare eligible individuals covered under your prescription drug coverage.  For example, these individuals could be on your active plans in some cases, disabled, on COBRA or retired.  To be certain that the Notice reaches spouses and dependents who may be Medicare eligible, the Notice should be sent to all employees and retirees.

Many groups use their open enrollment timeframe to send out the Notice.  However, the Notice must be received no later than October 15th each year.  It should also be provided by the employer to any Medicare eligible employee and/or retiree , spouse or dependent who is new to a plan or changes plans. It is essential that the employer provide this Notice to plan participants at these times and also upon request. If a plan participant does not have a Notice and then attempts to elect a Part D plan at another time, the participant may be subject to a late enrollment premium penalty.

Please keep copies of the Notice provided on file as a plan participant could request it from the employer at any time. If you have any questions, please contact Monica Smigliani 1-800-374-4405, x264 or Chris Bailey at x268.

Medicare Modernization Act and Creditable Coverage Background

What is the Medicare Modernization Act (MMA)?

• The MMA is a federal law enacted in 2003 that created a new Medicare prescription drug benefit (often referred to as Medicare Part D). Medicare Part D became effective January 1, 2006.
• Other key provisions of the MMA include:
  • Creating a new type of Medicare insurance plan to provide the new prescription drug benefit. They are called prescription drug plans or PDPs and Medicare Advantage Prescription Drug Plans or MA-PDs
  • Providing a subsidy to employers for maintaining qualified retiree drug programs.
  • Requiring employers who offer prescription drug coverage to notify plan participants ( retirees, COBRA participants, disabled employees and active employees and their dependents) who are Medicare beneficiaries whether their prescription drug plan meets minimum federal benefit standards (whether the coverage is creditable) .

• The test for creditable coverage is whether the employer's plan is expected to have, on average, a prescription drug claims payout (in aggregate) that is at least equal to the expected claims payout under the standard Part D benefit.

• If you have Medicare Part D related questions, please contact Monica Smigliani at 1-800-374-4405 x264, Chris Bailey at x268, or your Account Executive.

Sample Individual Creditable Coverage Disclosure 2013 (doc)

Sample Individual Creditable Coverage Disclosure 2013 (pdf)