Annually. employers must inform the Centers for Medicare and Medicaid Services (“CMS”) and participants and beneficiaries who qualify for Medicare Part D of the creditable or non-creditable status of the group health plan prescription drug plan(s). When prescription medication coverage meets or exceeds Medicare Part D, it is considered creditable. Any coverage that falls short of Medicare Part D’s quality standards is deemed non-creditable
As previously reported, the Inflation Reduction Act of 2022 (“IRA”) changed aspects of the Medicare Part D program to enhance and improve Medicare Part D coverage. The changes include:
A newly defined standard Part D benefit design consisting of three phases: annual deductible, initial coverage, and catastrophic coverage; o Donut Hole!
A lower annual out-of-pocket (“OOP”) threshold of $2,000;
The sunset of the Coverage Gap Discount Program (“CGDP”) and establishment of the Manufacturer Discount Program (“Discount Program”); and
Changes to the liability of enrollees, Part D sponsors, manufacturers, and CMS in the newly defined standard Part D benefit design. As a result of these changes, some employer sponsored prescription drug coverage may no longer qualify as creditable for the 2025 plan year. Contact your Total Benefit Solutions, Inc health insurance specialists today at (215)355-2121 if you have any questions!