Quick Answer: What Should Pennsylvania Employers Know About the Medicare Part D Notice?
If your Pennsylvania business offers prescription drug benefits, you generally need to tell Medicare-eligible individuals covered by the plan whether the prescription coverage is creditable or non-creditable. The annual notice must be provided before October 15, and employers or other plan sponsors generally have a separate creditable coverage reporting responsibility with CMS.
This article is for general educational purposes and is not legal, tax, or compliance advice. Employers should confirm specific Medicare Part D disclosure requirements with qualified benefits, legal, or compliance professionals when needed.
What Is Medicare Part D Creditable Coverage?
Creditable coverage means prescription drug coverage is expected to pay, on average, at least as much as Medicare’s standard prescription drug coverage. Employers offering prescription drug benefits need to determine whether their coverage meets that standard so Medicare-eligible participants can make informed decisions about Part D enrollment.
This determination matters because a Medicare beneficiary may face a Part D late enrollment penalty after a continuous period of 63 days or more without Part D or other creditable prescription drug coverage after the applicable initial enrollment period.
Which Medicare Part D Notice Should Employers Send?
The correct disclosure depends on the status of the prescription drug benefit. Coverage that meets Medicare’s standard should use a creditable coverage disclosure, while coverage that does not meet the standard requires a non-creditable coverage disclosure.
CMS provides model creditable and non-creditable notices that employers and other entities can modify for their benefit programs. If the carrier, prescription drug coverage, or plan design has changed, employers should confirm the current determination before relying on a notice used in a previous year.
Who Needs to Receive a Medicare Part D Notice?
Employers should not focus only on active employees who are age 65 or older. The disclosure requirement generally applies to Medicare-eligible individuals covered under the employer’s prescription drug plan.
That can include active employees and their covered dependents, COBRA participants and their dependents, retirees and their dependents, and individuals who qualify for Medicare because of a disability.
For example, an employee may not yet be eligible for Medicare, but a spouse covered under the same employer plan may be. The employer’s disclosure process should account for Medicare-eligible covered individuals, not simply the age of the employee.
When Does the Medicare Part D Notice Need to Be Sent?
The annual disclosure must be provided before October 15 each year. That timing gives Medicare-eligible participants information about their current prescription drug coverage before Medicare’s annual Part D enrollment period.
Disclosure may also be required at other times. CMS specifically identifies situations such as when a Medicare-eligible individual joins the prescription drug plan, so employers should not treat the October notice as the only time the requirement can arise.
Adding the notice to the company’s annual benefits compliance calendar can make it easier to coordinate with renewal, open enrollment, and other employee communications.
What Changed for Medicare Part D Creditable Coverage in 2026?
Employers should confirm their prescription drug plan’s creditable coverage status for 2026 rather than automatically relying on the previous year’s determination.
For calendar year 2026, CMS allows non-Retiree Drug Subsidy group health plans to use either the existing simplified determination methodology or a revised simplified determination methodology. Under the revised method, coverage generally must be designed to pay at least 72% of participants’ prescription drug expenses, compared with 60% under the existing methodology.
This does not mean HR teams necessarily need to perform the calculation themselves. The practical step for many employers is to confirm the current creditable or non-creditable determination with the insurance carrier, plan administrator, or benefits adviser before preparing the annual disclosure.
Do Employers Also Need to Report Creditable Coverage to CMS?
Yes, in most cases the participant notice and the CMS disclosure are separate responsibilities.
Entities providing prescription drug coverage to Medicare-eligible individuals generally must complete CMS’s online disclosure form no later than 60 days after the beginning of the plan year. A new disclosure is also generally required within 30 days after termination of the prescription drug plan or after a change in its creditable coverage status.
The CMS reporting requirement does not apply in the same way to Medicare beneficiaries for whom the entity is receiving the Retiree Drug Subsidy. Completing the employee notice also does not automatically complete the CMS filing, so employers should track the two responsibilities separately.
Can the Medicare Part D Notice Be Included With Other Benefits Materials?
Yes. Employers may provide the disclosure with other enrollment or benefits communications, but the Medicare Part D information should be easy for affected individuals to identify.
The goal is not simply to include the notice somewhere in a large packet. Medicare-eligible participants need to understand whether their current prescription coverage is creditable so they can make informed decisions about Medicare Part D.
Employers should also keep a record of the notice used, when it was provided, and which benefit plan or coverage determination it applied to.
What Should Pennsylvania Employers Review Before Sending the Notice?
Start with the current prescription drug benefit rather than last year’s notice. Confirm whether the coverage is creditable or non-creditable for the current plan year and identify Medicare-eligible individuals who may be covered through the plan.
Employers should also confirm that the correct notice is being used, review how and when it will be delivered, and make sure the separate CMS reporting requirement is on the compliance calendar.
These Medicare Part D requirements are federal. Pennsylvania employers generally follow the same CMS creditable coverage disclosure requirements that apply to employers in other states.
What Do Employers Ask About Medicare Part D Notices?
Medicare-eligible individuals covered by an employer’s prescription drug benefit generally need the disclosure. This can include active employees, covered dependents, COBRA participants, retirees, and individuals who qualify for Medicare because of a disability.
The annual notice must be provided before October 15 each year. Disclosure may also be required at other times, including when a Medicare-eligible individual joins the employer’s prescription drug plan.
Yes. The notice can be coordinated with enrollment, renewal, or other plan communications as long as affected individuals can clearly identify and understand the Medicare Part D disclosure.
The employer should provide the appropriate non-creditable coverage disclosure. This lets Medicare-eligible individuals know that the employer coverage does not meet Medicare’s creditable coverage standard so they can consider their Part D enrollment options.
Generally, yes. The online CMS disclosure is separate from the notice provided to Medicare-eligible individuals and reports whether the employer’s prescription drug benefit is creditable or non-creditable. It is generally due within 60 days after the start of the plan year, with additional filings required after certain changes or plan termination.
What Should Employers Do Before the Next Medicare Part D Notice Deadline?
Do not wait until October to determine whether the prescription drug benefit is creditable. Confirm the plan’s current status, identify Medicare-eligible covered individuals, prepare the correct disclosure, and make sure the separate CMS filing responsibility is being tracked.
JS Benefits Group works with Pennsylvania employers on group health plans, compliance support, plan administration, and employee benefits planning. Employers that need help reviewing their prescription drug coverage and broader benefits structure can learn more through JS Benefits Group’s employee benefits plan design services.
