Model Notice Letters | CMS
Summary: This document provides the official CMS model language for entities to notify Medicare-eligible individuals whether their current prescription drug coverage is considered 'creditable' compared to Medicare Part D standards.
This CMS model notice (Form 10182-CC, updated April 1, 2011) serves as a template for employers and plan sponsors to communicate the status of their prescription drug plans to Medicare-eligible participants. It explains the importance of 'creditable coverage'—coverage that is expected to pay out at least as much as standard Medicare Part D—and warns participants about the potential late enrollment penalty if they go 63 continuous days or longer without such coverage. The document includes placeholders for plan-specific details, contact information, and guidance on how the entity's plan coordinates with Medicare Part D.
Document outline
1. Important Notice About Your Prescription Drug Coverage and Medicare 2. Creditable Coverage Determination 3. When Can You Join A Medicare Drug Plan? 4. What Happens To Your Current Coverage If You Decide to Join A Medicare Drug Plan? 5. When Will You Pay A Higher Premium (Penalty) To Join A Medicare Drug Plan? 6. For More Information About This Notice Or Your Current Prescription Drug Coverage 7. For More Information About Your Options Under Medicare Prescription Drug Coverage 8. Optional Personalized Disclosure Notice Section