Changes to Medicare Part D Creditable Coverage

The Centers for Medicare & Medicaid Services (CMS) Medicare Part D prescription drug coverage will expand in 2025 as required under the Inflation Reduction Act (IRA), which could impact whether an employer’s group health plan provides creditable prescription drug coverage.
 
Plans that met creditable coverage status previously may no longer be creditable beginning in 2025. 
 
Employers who offer prescription drug coverage need to be aware of the Medicare Part D changes, take the required steps to understand the creditable status of their prescription drug plan(s) for 2025, and then clearly communicate status to eligible employees and report status to CMS.
 
Often an insurance carrier or third-party administrator (TPA) will provide information to a plan sponsor detailing whether a plan’s drug coverage is creditable. But if a plan sponsor does not receive this information from the carrier or TPA, the plan sponsor (e.g., the employer) is responsible for making the determination, or for hiring an actuary to help with the determination. 
 
Join us for a webinar as we discuss this change and the considerations for the upcoming year.