Medicare Part D Notices Are Due Before Oct. 15, 2025 | PA Employee Benefits Team 

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Webber Advisors
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Medicare Part D Disclosure Requirements

Every year, sponsors of group health plans must notify both Medicare Part D–eligible individuals and the Centers for Medicare & Medicaid Services (CMS) about whether the plan’s prescription drug coverage is considered creditable (meaning it provides coverage that is at least as good as Medicare Part D).

The annual notice must be delivered to Medicare-eligible individuals before Oct. 15, 2025, which is the start of Medicare Part D’s open enrollment period. To assist employers, CMS has developed model disclosure notices that can be used as templates.

This notice is especially important because Medicare beneficiaries who do not have creditable coverage and delay enrolling in Medicare Part D may face permanently higher premiums. While no penalty is levied against employers who fail to provide the notice, not doing so may negatively impact employees.

Action Steps

  • Plan sponsors must ensure the annual Medicare Part D notices are sent to Medicare-eligible individuals by the Oct. 15 deadline.
  • Employers should verify whether each of their health plan options (for example, PPO, HDHP, HMO) is creditable or non-creditable and prepare the appropriate Medicare Part D disclosure notice.
  • To simplify distribution, many employers include these notices in open enrollment materials provided before Oct. 15.

Creditable Coverage

A prescription drug benefit is “creditable” if its expected value is at least equal to the standard Medicare Part D benefit. This determination is based on actuarial analysis of anticipated paid claims. Each benefit option must be assessed separately.

Model Notices

CMS offers two model notices for employers:

  • Creditable Coverage Disclosure Notice – for plans that meet or exceed Medicare Part D standards.
  • Non-creditable Coverage Disclosure Notice – for plans that do not meet those standards.

Model notices are also available in Spanish. Employers are not required to use the models, but if they create their own, the notice must include:

  • Whether the coverage is creditable or non-creditable;
  • An explanation of what creditable coverage means; and
  • Why the disclosure matters.

Who Must Receive the Notice

The disclosure must be provided to all Medicare Part D–eligible individuals who are covered by, or who apply for, the plan’s prescription drug benefit. This includes:

  • Active and disabled employees,
  • COBRA participants,
  • Retirees, and
  • Their spouses and dependents.

Typically, employers provide the notice to all plan participants to simplify compliance.

Timing of Notices

At a minimum, these disclosures must be distributed:

If the creditable coverage disclosure notice is provided to all plan participants annually before Oct. 15 of each year, items (1) and (2) above will be satisfied. “Prior to,” as used above, means the individual must have been provided with the notice within the past 12 months. In addition to providing the notice each year before Oct. 15, plan sponsors should consider including the notice in plan enrollment materials for new hires.

Method of Delivering Notices

Plan sponsors have flexibility in how they must provide their creditable coverage disclosure notices. The disclosure notices can be provided separately, or if certain conditions are met, they can be provided with other plan participant materials, like annual open enrollment materials. The notices can also be sent electronically in some instances.

As a general rule, a single disclosure notice may be provided to the covered Medicare beneficiary and all of their Medicare Part D-eligible dependents covered under the same plan. However, if it is known that any spouse or dependent who is eligible for Medicare Part D lives at a different address than where the participant materials were mailed, a separate notice must be provided to the Medicare-eligible spouse or dependent residing at a different address.

ELECTRONIC DELIVERY

Creditable coverage disclosure notices may be sent electronically under certain circumstances. CMS has issued guidance indicating that health plan sponsors may use the electronic disclosure standards under Department of Labor (DOL) regulations in order to send the creditable coverage disclosure notices electronically. According to CMS, these regulations allow a plan sponsor to provide a creditable coverage disclosure notice electronically to plan participants who have the ability to access electronic documents at their regular place of work, if they have access to the sponsor’s electronic information system on a daily basis as part of their work duties.

The DOL’s regulations for electronic delivery require that:

  • The plan administrator uses appropriate and reasonable means to ensure that the system for furnishing documents results in actual receipt of transmitted information;
  • Notice is provided to each recipient, at the time the electronic document is furnished, of the significance of the document; and
  • A paper version of the document is available on request.

Also, if a plan sponsor uses electronic delivery, the sponsor must inform the plan participant that they are responsible for providing a copy of the electronic disclosure to their Medicare-eligible dependents covered under the group health plan.

In addition, the guidance from CMS indicates that a plan sponsor may provide a disclosure notice electronically to retirees if the Medicare-eligible individual has indicated to the sponsor that they have adequate access to electronic information. According to CMS, before individuals agree to receive their information via electronic means, they must be informed of their right to obtain a paper version, how to withdraw their consent and update address information, and any hardware or software requirements to access and retain the creditable coverage disclosure notice.

If the individual consents to an electronic transfer of the notice, a valid email address must be provided to the plan sponsor and the consent from the individual must be submitted electronically to the plan sponsor. According to CMS, this ensures the individual’s ability to access the information and that the system for furnishing these documents results in actual receipt. In addition to having the disclosure notice sent to the individual’s email address, the notice (except for personalized notices) must be posted on the plan sponsor’s website, if applicable, with a link on the sponsor’s homepage to the disclosure notice.

DISCLOSURE TO CMS

Plan sponsors are also required to disclose to CMS whether their prescription drug coverage is creditable. The disclosure must be made to CMS on an annual basis, or upon any change that affects whether the coverage is creditable. At a minimum, the CMS creditable coverage disclosure notice must be provided at the following times:

  • Within 60 days after the beginning date of the plan year for which the entity is providing the form;
  • Within 30 days after the termination of the prescription drug plan; and
  • Within 30 days after any change in the creditable coverage status of the prescription drug plan.

Plan sponsors are required to provide the disclosure notice to CMS through completion of the disclosure form on the CMS Creditable Coverage Disclosure webpage. This is the sole method for compliance with the CMS disclosure requirement, unless a specific exception applies.