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 (1) to make and annual determination as to whether their coverage is creditable or non-creditable coverage (2) provide this information to plan participants and (3) report the creditability status of their plan(s) to CMS. Plans must notify plan participants of their creditable or non-creditable status annually before the Medicare enrollment period beginning on October 15th and have the notice available upon request.

For calendar year 2025, new guidance was released allowing plan sponsors to choose between either the original simplified determination method (2009) or the revised simplified determination method (2025) for calculating whether their prescription drug plan design is creditable or non-creditable under the simplified determination method strategy. (Actuarial analyses are still available for groups seeking the Retiree Drug Subsidy). 

The definition of “creditable coverage” for calculation purposes varies slightly between the original simplified determination method and the revised simplified determination. Generally, under both calculation options a plan must be designed to cover, on average, at least as much as a standard Medicare Part D plan, or be designed to cover an approximate percentage of the plan participants’ out of pocket costs on their current prescription drug plan, to be considered “creditable coverage”. A “non-creditable” plan design would fall below these designated thresholds during calculation. For a full side by side comparison you can see our Calculation Method Comparison Chart.  

Plans are not required to offer creditable coverage to plan participants to be considered in compliance with the rules. Some plan sponsors may also offer a variable mix of both creditable and non-creditable plan options. 

To sign up, please complete the form on the next page. Click here for more in-depth information regarding Medicare creditable coverage compliance.

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

 

If you have questions about how many plan options you sponsor and how many creditable coverage calculations you should complete under this compliance requirement, please contact us at creditablecalc@lumelight.com. 

To continue to sign-up, click next.