August 23, 2022
On an annual basis, The Centers for Medicare and Medicaid Services (CMS) require all employers who provide a group health plan to their employees to disclose whether the plan has creditable drug coverage under Medicare Part D.
Employers must notify CMS and all Medicare-eligible participants in the health plan of the plan’s drug coverage status. Individuals are Medicare-eligible if entitled to Medicare A and/or enrolled in Part B.
Individuals who fail to enroll in Medicare Part D prescription drug coverage when first eligible may be subject to late enrollment penalties if they go 63 consecutive days or longer without creditable prescription drug coverage.
Creditable prescription drug coverage is coverage that is expected to pay at least as much as Medicare’s standard prescription drug coverage. A drug plan is creditable if it:
Required Creditable Coverage Disclosures to CMS and to Eligible Employees
Medicare Part D imposes two annual notice requirements on employers who offer group health plan coverage with a prescription drug benefit:
Employers who contract with Medicare directly as a Part D plan or that contract with a Part D plan to provide qualified prescription drug coverage are exempt from the disclosure requirement.
If you have further questions, don’t hesitate to contact us.
September 8, 2023
Tenth Circuit Court of Appeals Hands Down a Big Win for ERISA Preemption After several failed attempts by pharmacy benefit managers (“PBM”) to challenge state laws regulating PBMs, the 10th Circuit Court of Appeals (in Pharmaceutical Care Management Association v. Mulready) handed down a big win for PBMs and, by extension, self-funded ERISA plans, when […]
August 28, 2023
IRS Issues Affordability Percentage Adjustment for 2024 The Internal Revenue Service (IRS) has released Rev. Proc. 2023-29, which contains the inflation adjusted amounts for 2024 used to determine whether employer-sponsored coverage is “affordable” for purposes of the Affordable Care Act’s (ACA) employer shared responsibility provisions and premium tax credit program. As shown in the table […]