The Centers for Medicare and Medicaid Services (CMS) has released a final rule that exempts account-based plans, such as health reimbursement arrangements (HRAs) and health flexible spending accounts (FSAs), from Medicare Part D disclosure requirements. The change applies to coverage beginning Jan. 1, 2027.
As background, employers with group health plans that provide prescription drug coverage to individuals who are eligible for Medicare Part D must inform both those individuals and CMS whether that coverage is creditable. A group health plan’s prescription drug coverage is considered creditable if its actuarial value equals or exceeds the actuarial value of standard Medicare Part D prescription drug coverage; coverage that does not meet this standard is deemed noncreditable.
For this purpose, the term “group health plan” includes account-based medical plans such as HRAs and health FSAs, to the extent they are employee welfare benefit plans that provide medical care.
The final rule exempts account-based plans, such as health FSAs and HRAs (including individual coverage HRAs, or ICHRAs), from the creditable coverage disclosure requirements. According to CMS, these account-based plans do not actually offer prescription drug coverage; rather, they are designed to provide savings on health care costs through pretax contributions and reimbursements to supplement other health coverage. CMS explains that requiring these plans to determine if their coverage is creditable and report that status unduly increases administrative burden and could result in confusion for beneficiaries.
Employers should continue to comply with existing creditable coverage disclosure requirements until the rule takes effect, keeping in mind that the exclusion applies only to account-based plans. Group health plans that offer prescription drug coverage remain subject to the Medicare Part D disclosure requirements.
Contact us to see how you could minimize risk:
- |