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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.”
- 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.
- Ask the health insurance carrier (for insured coverage)
- Simplified determination (for certain plan designs)
- Actuarial determination (for all other plans)
CMS’ Creditable Coverage web page includes information and resources about the Medicare Part D disclosure requirements, including:
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