Creditable Coverage

The Medicare Modernization Act (MMA) requires entities (whose policies include a prescription drug plan) to notify Medicare-eligible policyholders whether their prescription drug plan is creditable, which means that the coverage is expected to pay on average as much as the standard Medicare Part D plan. 

How and when to provide disclosures:

Employers that offer prescription drug coverage to employees or former employees who are eligible for Medicare must provide these individuals with an annual notice saying whether their coverage is creditable or non-creditable. This notification must take place before Oct. 15. The disclosure provides Medicare beneficiaries with important information related to their Medicare Part D enrollment.

CMS has provided model/sample language that you can (but are not required to) use to disclose creditable coverage status to beneficiaries.  You may download the sample language on their website.

Employers are required to provide the disclosure notice by  completing the disclosure form on the CMS website. This is the sole method for complying with the CMS notice requirement.

The disclosure notice must be made annually within 60 days after the beginning of the plan year. For example, plans with a Jan. 1 renewal date must submit their disclosure no later than Feb. 28. Additionally, disclosure to CMS must be made within 30 days after the termination of a prescription drug plan and within 30 days after any change in the creditable coverage status of a prescription drug plan. To make this disclosure,  complete the form on the CMS website.

2021 Creditable Coverage

Beginning Jan. 1, 2020, small and mid-size employers will be able to view their creditability status online. We will no longer mail annual Notice of Creditable Coverage letters to these employers. Fully insured and ASO groups with 151+ employees will continue to receive their future creditability plan status in the mail within 60 days of their plan’s effective date. 

Please view the test results below to determine if a group's 2019 or 2020 plan is creditable or non-creditable.
2019 Creditability Test Results (2019 BCBSNE plans tested against 2019 Medicare Part D)
2020 Creditability Test Results (2020 BCBSNE plans tested against 2020 Medicare Part D)
2021 Creditability Test Results (2021 BCBSNE plans tested against 2021 Medicare Part D)

How will my group find its Creditable Coverage status?

Each group will get its Creditable Coverage status in a different way depending on its size. Use the table below to determine where Creditable Coverage status can be found.

Creditable Coverage Status Availability
Group Size Mail
Small Group (2-50 employees)
Small Group Level-funded (5-50 employees)
Mid-size Group (51-150 employees)
Large Group Fully Insured (151+ employees)
Large Group Self-funded (151+ employees)

If you have any questions, please contact your insurance agent/broker or a member of your BCBSNE account management team.