Compliance Alert: Determining Whether Prescription Drug Coverage Is Creditable - Apex Benefits

Compliance Alert: Determining Whether Prescription Drug Coverage Is Creditable

 

A group health plan’s prescription drug coverage is considered creditable if its actuarial value equals or exceeds the actuarial value of standard Medicare Part D prescription drug coverage. Prescription drug coverage that does not meet this standard is called “non-creditable.”

 

Highlights

Creditable Coverage

  • Employers with prescription drug coverage must determine whether their coverage is creditable.
  • Medicare Part D requires employers to disclose to CMS and to Medicare Part D-eligible individuals whether their prescription drug coverage is creditable.
  • There is no employer fee or penalty for offering prescription drug coverage that is non-creditable.

Determination Methods

  • Ask the health insurance carrier (for insured coverage)
  • Simplified determination (for certain plan designs)
  • Actuarial determination (for all other plans)

Resources

CMS’ Creditable Coverage web page includes information and resources about the Medicare Part D disclosure requirements, including:

 

 

Source: © 2018 Zywave, Inc.

 

Contact