#Ep 499 Understanding Medicare Creditable Coverage: Compliance Insights with Marissa Rufo

The ShiftShapers Podcast

In this episode of the ShiftShapers Podcast, host David Saltzman chats with Marissa Rufo, JD, MBA, a subject matter expert from MZQ Consulting, to demystify the complexities surrounding Medicare Creditable Coverage. They discuss why it's significant for employers and employees alike, particularly in light of recent legislative changes and the growing number of older employees in the workforce. The conversation addresses compliance requirements, methods for determining creditable coverage, and practical steps employers need to take to avoid penalties and lawsuits.
Medicare creditable coverage is a requirement for group health plans to be comparable to an average Medicare Part D plan. The consternation and confusion around creditable coverage has increased due to recent changes in legislation and the growing number of Medicare-eligible individuals still working full-time. Employers have a fiduciary duty to ensure compliance with creditable coverage requirements, as failure to do so can result in lawsuits and penalties. While employers are not required to have actual creditable coverage, they must determine the creditability of their prescription drug plans, provide notices to Medicare-eligible employees, and report their credibility status to CMS annually. Failure to provide accurate notices can result in financial costs and penalties for employees. There are two methods for calculating creditable coverage: the simplified determination method and the actuarial analysis method. Brokers can help employers navigate the compliance requirements and ensure they are providing the necessary notices to all Medicare-eligible individuals. MZQ Consulting offers affordable testing services to help employers determine the creditability of their prescription drug plans.

Takeaways

• Medicare creditable coverage is a requirement for group health plans, comparable to an average Medicare Part D plan.
• Employers have a fiduciary duty to ensure compliance with creditable coverage requirements.
• Failure to provide accurate notices can result in financial costs and penalties for employees.
• Brokers can help employers navigate the compliance requirements and ensure they are providing the necessary notices to all Medicare-eligible individuals.
• MZQ Consulting offers affordable testing services to help employers determine the creditability of their prescription drug plans.

Chapter

1. Understanding Medicare Creditable Coverage (00:00:00)

2. Employer Responsibilities for Medicare Coverage (00:09:06)

3. Medicare Creditable Coverage Calculation Methods (00:12:40)

4. Compliance in Health Insurance Industry (00:22:35)