Creditable Coverage Notices Are Due Before October 15th, Every Year.
Employers with prescription drug coverage must tell Medicare-eligible people whether it is creditable, and must tell CMS. The notice is short. Missing it is not.
People often call this the certificate of creditable coverage. Today the document is the Medicare Part D creditable coverage notice, plus a separate online disclosure to CMS. The old HIPAA certificate of the same name has not been required since 2015. Find your own filing dates with our Part D creditable coverage deadline calculator.
This page explains what each document is, when each is due, who decides whether your coverage is creditable, and what the notice does for an employee who later enrolls in Part D.
What Is Actually True About Creditable Coverage
What Is Actually True
- Creditable means the plan’s prescription drug coverage is expected to pay on average at least as much as standard Medicare Part D.
- There are two required disclosures: a written notice to Medicare-eligible individuals, and an online disclosure to CMS.
- The notice has to say whether the coverage is creditable or non-creditable, and the two carry different content.
- A Medicare-eligible person who goes 63 days or more without creditable drug coverage after their initial Part D enrollment period may pay a late-enrollment penalty of at least 1% of the base premium for each month without it, for as long as they stay in Part D.
- The notice doubles as proof. A person who delays Part D may need to show they kept creditable coverage, and copies of disclosure notices count.
- The CMS online disclosure does not apply to plans receiving the Retiree Drug Subsidy.
- The old HIPAA certificate of creditable coverage, which proved prior coverage for pre-existing condition rules, has not been required since 2015, because the ACA ended those rules.
What CFH Does About It
- We get the creditable determination from the carrier or actuary at every renewal. It never comes from the employer.
- We prepare the notice from the CMS model language and set the distribution date well before October 15.
- We build the distribution list from enrollment, so COBRA participants, retirees and covered dependents are included.
- We file the CMS disclosure and keep the record.
- We rerun the check when drug benefits change, because a new design can change the answer.
- We keep copies of what went out and when, so an employee who asks for proof later gets it.
Six Moments the Clock Runs
Two disclosures, and the events that trigger each one.
Before October 15
The written notice goes to every Medicare-eligible person covered under the drug plan, before Part D annual enrollment begins.
When Someone Joins
A Medicare-eligible person who joins the plan gets the notice at that point, not only in the fall. Build the notice into your new-hire and new-enrollee packet so it goes out with the other enrollment materials. That way the timing does not depend on someone remembering, and you can show later that the person received it when they became covered under the plan.
When Status Changes
If coverage ends or moves between creditable and non-creditable, the notice has to follow. Ask your carrier to tell you promptly when a plan’s creditable status changes, and review plan design changes before they take effect. Updated notices then go out on time, and covered people are not left relying on an earlier notice that no longer applies.
On Request
Anyone covered who asks gets a copy of the notice. Keep a current copy of the notice where HR can find it quickly, along with the carrier’s determination behind it. A request can come from an employee, a spouse or a retiree, so having the document ready lets you respond without scrambling.
Within 60 Days of Plan Year Start
The online CMS disclosure is due no later than 60 days from the start of the plan year, about the end of February for a calendar-year plan. Put this date on your compliance calendar when you set up the plan year, and assign someone to complete the online filing. If the plan year is not a calendar year, the date moves with it, so confirm the timing with your adviser.
Within 30 Days of an Ending or Change
The CMS disclosure is also due within 30 days after the plan ends or its creditable status changes. A change in creditable status can come from a carrier switch or a plan design change, so involve whoever handles filings before the change is finalized. Keep the carrier’s determination and the filing confirmation together in your compliance records.
Where Creditable Coverage Goes Wrong
Six places the paperwork breaks.
The notice goes out late, or only to employees, and misses retirees, COBRA participants and covered dependents.
What we do about it: We build the list from enrollment, not from payroll, and send before the deadline.
People under 65 can be Medicare-eligible through disability, and employers often cannot tell who is eligible from the file.
What we do about it: We decide with you whether to send to everyone covered, which is the safer approach when eligibility is unclear.
The notice is sent but the CMS filing is never made, because it is a separate step with a separate deadline.
What we do about it: We calendar both and file the disclosure ourselves.
A change to the drug benefit can flip coverage from creditable to not, and the notice and filing change with it.
What we do about it: We ask for the determination again at every renewal and treat a change as a trigger.
If the coverage is not creditable, the notice says so and tells people to consider Part D, and employees need that message before they miss their window.
What we do about it: We confirm the determination first, then use the matching notice, so the message is right.
People who leave the active group are still Medicare-eligible, and still need the notice.
What we do about it: We include COBRA participants and retirees in the same distribution.
Questions Employers Ask About Creditable Coverage
Who Decides If Our Coverage Is Creditable?
The carrier or an actuary, never the employer. We collect the determination and use it for the notice and the filing.
Can We Use the CMS Model Notice?
Yes. CMS publishes model notices, and using their language is the simplest way to stay on safe ground.
Do We Send It to Everyone?
Only Medicare-eligible people require it. Because employers often do not know who is eligible, many send it to everyone covered. We can help decide which approach fits.
Why Does the Notice Matter to the Employee?
A Medicare-eligible person who goes 63 days or more without creditable drug coverage may face a lasting late-enrollment penalty on Part D premiums. The notice is their proof.
What if We Missed October 15?
Send it as soon as possible and tell us. Do not wait for the next cycle.
Does Anyone Still Need a HIPAA Certificate?
Not for pre-existing condition rules, which no longer exist, and the certificate has not been required since 2015. If someone asks for proof of coverage dates, we can provide a written statement.
What Is the Difference Between Creditable and Non-Creditable?
Creditable coverage is expected to pay on average as much as standard Part D. The notice says which applies, and non-creditable coverage carries a different message about enrolling in Part D.
Does the Retiree Drug Subsidy Change Anything?
Plans that receive the Retiree Drug Subsidy do not use the online CMS disclosure for those individuals. If you take the subsidy, tell us and we handle the right process.
What Counts as Proof When an Employee Enrolls Later?
Copies of the disclosure notices they received count. That is why we keep a record of what went out and when.
Send Us Your RenewalSee Benefits Administration and Technology
Related reading: Form 1095-B · Proof of qualified health coverage · Letter of eligibility
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