The Creditable Coverage Calculator service allows plan sponsors to easily determine the Medicare Creditable Coverage status of their prescription drug plan offerings and properly notify their plan participants in alignment with compliance requirements.

Under the Medicare Creditable Coverage rules, plan sponsors that offer prescription drug coverage are required to:

1. Make an annual determination as to whether their coverage is creditable or non-creditable,
2. Provide this information to plan participants in an annual notice,
3. Report this creditability status to CMS for all their plans.

This notice must be made available to plan participants annually by October 14th, so that Medicare-eligible individuals can understand their options prior to the Medicare open enrollment period. Plans must also be able to produce this notice upon request.

The definition of “creditable coverage” generally means the plan covers an estimated value equivalent to or better than the average Medicare Part D plan. “Non-creditable coverage” plan designs generally fall below this threshold. Plans are not required to offer creditable coverage to plan participants to be considered in compliance with the regulations. Some plan sponsors may also offer a variable mix of both creditable and non-creditable plan options.

For calendar year 2026, CMS released new guidance clarifying their intent to only allowing two forms of creditability calculation methods going forward: an actuarial analysis or the revised simplified determination method (2026). Actuarial analyses are ONLY required if the group plan is seeking the Retiree Drug Subsidy. Per this guidance, Lumelight's Creditable Coverage Calculator service utilizes the revised simplified determination method.

Please note that for purposes of this calculation and plan notice requirement, a “plan” is considered each distinct prescription drug plan offered by the legal entity/employer plan sponsor (or, in some instances, an association, trust, committee, etc.). In many cases, employer plan sponsors offer multiple prescription drug benefit plan options (e.g., gold, silver, PPO Low, PPO High, etc.) or specific prescription drug carve-out benefits. 

This service is priced based on plan options:

Each Prescription Drug Plan Offering: $300

Example:
Plan Option 1 Calculation:	$300
Plan Option 2 Calculation:	$300
Client Total:	$600

 

This service is also offered as one of Lumelight's Compass solutions and may be part of a compliance services package. If you are interested in learning more about this please reach out to info@lumelight.com. 

If you have questions about your determination or the service itself, please reach out to us at creditablecalc@lumelight.com. 

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Included Deliverables

Lumelight will:

• Determine whether each submitted prescription drug plan is creditable or non-creditable using CMS's revised simplified determination method, as applicable.
• Provide a written determination.
• Provide the applicable model Medicare Creditable Coverage Notice.

Client Responsiblities

Client is responsible for:

• Providing complete and accurate plan information.
• Responding promptly to requests for additional information.
• Distributing any required Medicare notices to eligible individuals.
• Reviewing and implementing the determination as appropriate.

Period of Performance

Services begin upon receipt of the completed request and are expected to be completed within ninety (90) days.

Acceptance

By signing below, I represent that I am authorized to submit this Order Form on behalf of the employer identified above ("Client"). The Client acknowledges that the Services are governed by the Lumelight Master Service Terms located at https://lumelight.com/terms/master-service-terms/, which are incorporated into this Order Form by reference.