Medicare beneficiaries can receive subsidized prescription drug coverage through the Medicare Part D program. Beneficiaries who have other sources of drug coverage—through a current or former employer or union, for example—may choose not to enroll in Medicare Part D, if their existing coverage pays, on average, as much as the standard Medicare prescription drug coverage.
This is what is referred to as “creditable coverage.”
As part of the Medicare Modernization Act (MMA), employers and union groups offering prescription drug coverage must disclose to Medicare eligible individuals with prescription drug coverage under their plan, whether the coverage is creditable.
If you have an employer group that offers a prescription drug plan to Medicare eligible individuals, understand that:
- Excellus BCBS performs annual actuarial testing on the employer group plans to determine creditability.
- If the group’s plan was creditable in 2024, it should remain creditable for 2025.
- CMS will continue to permit use of the creditable coverage simplified determination methodology, without modification to the existing parameters, for calendar year 2025.
If there is a question about a specific plan, please contact your account consultant.
Employer Group Responsibility
Employers must provide Notice of Creditable Coverage (NOCC) to all Medicare eligible individuals who are covered under the entity’s prescription drug plan. CMS publishes model communication templates that can be found at Model Notice Letters | CMS
- This is mandatory and required no later than October 15, 2024.
- The employer group is required to send the notices to members, not Excellus BCBS.
For additional information regarding creditable coverage, please visit The Centers for Medicare and Medicaid Services (CMS) Creditable Coverage website or contact your account consultant.
