Meeting compliance and regulatory requirements
Health insurance is complex, but Moda Health experts can help you keep up with compliance and regulatory requirements. Our account services team, in-house legal and regulatory teams, and underwriting and actuarial teams can help with health care reform updates and data to fulfill required notices and reporting.
Why do employers need to send notices to participants?
Whether or not your group offers creditable coverage can have a major impact on how your participants pay for their prescription drug coverage and whether they could face a penalty on Medicare Part D.
If your group offers creditable coverage, then Medicare-eligible participants will not be penalized if they delay enrollment in Medicare Part D.
If your group does not offer creditable coverage, your Medicare-eligible participants may want to enroll in Medicare Part D. If they choose not to enroll in Medicare (medical) and Medicare Part D during open enrollment, they may pay a penalty for Part D if they enroll in the future. The penalty will last for the whole time the member has Medicare drug coverage.
Participants can avoid the late enrollment penalty if they buy a Medicare Part D plan within 63 days of the day creditable coverage ended.
Creditable coverage for Medicare-eligible participants
If your plan includes coverage for prescription drugs, you may need to disclose some extra information to your plan participants and the Centers for Medicare and Medicaid Services (CMS). Follow the steps below to see which actions you should take.
Step 1: Determine whether you need to make disclosures
Start with the following questions:
- Do you have participants who are eligible for Medicare?
- Do you offer health plans with prescription drug coverage?
If you answered yes to both questions, you must disclose whether this coverage is "creditable” to all Medicare-eligible individuals and CMS. Follow the rest of the steps to do this.
If you answered no to either question, you don’t need to do anything else.
Step 2: Check whether your Moda Health plan coverage is creditable
According to CMS, coverage is creditable if your plan expects to pay on average as much as the standard Medicare prescription drug coverage. Use the charts below to check whether your Moda Health plan is creditable:
Step 3: Disclose coverage to plan participants
Send a Creditable Coverage Notice or Non-Creditable Coverage Notice to all Medicare-eligible individuals by Oct. 15 each year. See sample notices from CMS.
You may also need to send this notice at other times — for example, when someone who is eligible for Medicare joins your plan. See the CMS website for guidance.
Step 4: Disclose coverage to CMS
To report the status of your creditable coverage to CMS, complete the Online Disclosure to CMS Form. You must provide disclosures within:
- 60 days from the beginning of the plan year (contract year, renewal year);
- 30 days after the termination of a prescription drug plan; or
- 30 days after any change in creditable coverage status
See the CMS website for additional guidance.