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Medicare & Employers

Medicare is a federal health insurance program- funded in part by employers through a payroll tax- that is divided into four parts. Part A is hospital insurance; Part B is medical insurance; Part C is Medicare Advantage; and Part D is prescription drug coverage.

Special Update: Medicare is no longer prevented from recognizing same-sex marriages for determining entitlement to, or eligibility for, Medicare. The Social Security Administration is now processing requests for Medicare Part A and Part B Special Enrollment Periods, as well as reductions in late enrollment penalties, for certain eligible individuals in same-sex marriages. Click here for more information.

Medicare Payroll Tax

Through the FICA payroll tax, employers and employees fund Medicare's Hospital Insurance (HI) program.  

  • Tax rates under the HI program are 1.45% for employees and employers, each, and 2.90% percent for self-employed persons.

Employer Notice Requirements under Medicare Part D (Creditable Coverage)

  • The Medicare Modernization Act (MMA) requires entities (whose policies include prescription drug coverage) to notify Medicare eligible policyholders whether their prescription drug coverage is creditable coverage, which means that the coverage is expected to pay, on average, as much as the standard Medicare prescription drug coverage. For these entities, there are two disclosure requirements:
    • The first disclosure requirement is to provide a written disclosure notice to all Medicare eligible individuals annually who are covered under its prescription drug plan, prior to October 15th each year and at various times as stated in the regulations, including to a Medicare eligible individual when he/she joins the plan. This disclosure must be provided to Medicare eligible active working individuals and their dependents, Medicare eligible COBRA individuals and their dependents, Medicare eligible disabled individuals covered under your prescription drug plan and any retirees and their dependents. The MMA imposes a late enrollment penalty on individuals who do not maintain creditable coverage for a period of 63 days or longer following their initial enrollment period for the Medicare prescription drug benefit. Accordingly, this information is essential to an individual's decision whether to enroll in a Medicare Part D prescription drug plan.
    • The second disclosure requirement is for entities to complete the Online Disclosure to CMS Form to report the creditable coverage status of their prescription drug plan. The Disclosure should be completed annually no later than 60 days from the beginning of a plan year (contract year, renewal year), within 30 days after termination of a prescription drug plan, or within 30 days after any change in creditable coverage status.
     

Medicare Model Disclosure Notices    

  • Disclosure to CMS Guidance and Instructions  
  • Disclosure to CMS (Online) Form 
  • Model Individual Creditable Coverage Disclosure Notice (PDF) 
  • Model Individual Creditable Coverage Disclosure Notice - Spanish (PDF) 
  • Model Individual Non-Creditable Coverage Disclosure Notice (PDF) 
  • Model Individual Non-Creditable Coverage Disclosure Notice - Spanish (PDF)  

For additional information, see the CMS Medicare pages.


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