Creditable and non-creditable coverage
Under regulations issued by the Centers for Medicare & Medicaid Services (CMS), Medicare Part D-eligible individuals must be notified whether their current coverage is "creditable prescription drug coverage" each year. The following are definitions of creditable and non-creditable coverage:
- Creditable coverage: A health plan's prescription drug coverage is creditable when the amount the plan expects to pay for prescription drugs for individuals covered by the plan in the coming year is, on average, the same or more than what standard Medicare prescription drug coverage would be expected to pay.
- Non-creditable coverage: A health plan's prescription drug coverage is non-creditable when the amount the plan expects to pay for prescription drugs for individuals covered by the plan in the coming year is, on average, less than that which standard Medicare prescription drug coverage would be expected to pay.
Employers must notify Medicare-eligible group members whether their current plan is or is not creditable prescription drug coverage by October 15. Blue Shield notifies IFP plan subscribers and Medicare Supplement members via annual mailings. Members in Blue Shield plans that have been determined as creditable do not need to do anything if they're satisfied with the drug coverage they have through these plans.
Members in Blue Shield plans that have been determined to have non-creditable coverage may do one of the following:
- Do nothing and keep their current coverage. If they choose this option, they are not purchasing a Medicare Prescription Drug Plan (PDP) and may incur further late enrollment penalties if they choose to purchase a Medicare PDP in the future. There are no forms to fill out for this choice.
- Purchase a Medicare Prescription Drug Plan during the next Annual Election Period. The late enrollment penalty will apply because the member's current plan is not creditable, and the employee did not choose to enroll in a Medicare PDP when they first became eligible. Within 63 days of enrolling in a Medicare PDP, employees must have the prescription drug coverage removed from their current plan per federal law.
The list below denotes which Blue Shield of California plans offer creditable prescription drug coverage and which do not. Effective January 1, 2027.
Individual and Family Plans
| Plan type | Creditable plans | Non-creditable plans |
|---|---|---|
| IFP: PPO plans | Blue Shield $0 Cost Share PPO AI-AN |
Blue Shield Bronze 60 HDHP PPO |
| IFP: HMO plans | Blue Shield $0 Cost Share Trio HMO AI-AN |
Blue Shield Bronze 60 Trio HMO (NEW) |
Medicare Supplement
| Plan type | Creditable plans | Non-creditable plans |
|---|---|---|
| Medicare Supplement plans | None | Plan H Plus Rx (closed plan) Plan I Plus Rx (closed plan) Golden Coronet Senior Plus Rx (closed plan) Coronet Senior Plus Rx (closed plan) |
Small Business Plans
| Plan type | Creditable plans | Non-creditable plans |
|---|---|---|
| Small Business plans | All plans except those listed in the non-creditable plans column |
2027: 2026: |
Midsize and Large Group
| Plan type | Creditable plans | Non-creditable plans |
|---|---|---|
| HMO/POS plans | Basic Rx $10/15 with $0 Pharmacy Deductible (Not Marketed) Basic Rx $10/15 with $150 Pharmacy Deductible (Not Marketed) Basic Rx $10/20 with $0 Pharmacy Deductible Basic Rx $10/20 with $150 Pharmacy Deductible Basic Rx $10/20 with $250 Pharmacy Deductible Basic Rx $10/25 with $0 Pharmacy Deductible Basic Rx $10/25 with $150 Pharmacy Deductible Basic Rx $15/25 with $0 Pharmacy Deductible (Not Marketed) Basic Rx $15/25 with $150 Pharmacy Deductible (Not Marketed) Basic Rx $15/25 with $250 Pharmacy Deductible (Not Marketed) Basic Rx $15/30 with $0 Pharmacy Deductible Basic Rx $15/30 with $150 Pharmacy Deductible Basic Rx $15/30 with $250 Pharmacy Deductible Enhanced Rx $5/10/25 with $0 Pharmacy Deductible Enhanced Rx $5/10/25 with $150 Pharmacy Deductible Enhanced Rx $10/15/30 with $0 Pharmacy Deductible Enhanced Rx $10/15/30 with $150 Pharmacy Deductible Enhanced Rx $10/20/35 with $0 Pharmacy Deductible Enhanced Rx $10/20/35 with $150 Pharmacy Deductible Enhanced Rx $10/25/40 with $0 Pharmacy Deductible Enhanced Rx $10/25/40 with $150 Pharmacy Deductible Enhanced Rx $10/25/40 with $250 Pharmacy Deductible Enhanced Rx $10/30/50 with $0 Pharmacy Deductible Enhanced Rx $10/30/50 with $150 Pharmacy Deductible Enhanced Rx $10/30/50 with $250 Pharmacy Deductible Enhanced Rx $10/40/60 with $0 Pharmacy Deductible Enhanced Rx $10/40/60 with $150 Pharmacy Deductible Enhanced Rx $10/40/60 with $250 Pharmacy Deductible Enhanced Rx $15/30/45 with $0 Pharmacy Deductible Enhanced Rx $15/30/45 with $150 Pharmacy Deductible Enhanced Rx $15/30/45 with $250 Pharmacy Deductible Enhanced Rx $15/30/50 with $0 Pharmacy Deductible Enhanced Rx $15/30/50 with $150 Pharmacy Deductible Enhanced Rx $15/30/50 with $250 Pharmacy Deductible Enhanced Rx $15/40/70 with $0 Pharmacy Deductible Enhanced Rx $15/40/70 with $150 Pharmacy Deductible Enhanced Rx - Value Formulary $10/20/35 with $0 Pharmacy Deductible Enhanced Rx - Value Formulary $10/20/35 with $150 Pharmacy Deductible Enhanced Rx - Value Formulary $10/25/40 with $0 Pharmacy Deductible Enhanced Rx - Value Formulary $10/25/40 with $150 Pharmacy Deductible Enhanced Rx - Value Formulary $10/25/40 with $250 Pharmacy Deductible Enhanced Rx - Value Formulary $10/30/50 with $0 Pharmacy Deductible Enhanced Rx - Value Formulary $10/30/50 with $150 Pharmacy Deductible Enhanced Rx - Value Formulary $10/30/50 with $250 Pharmacy Deductible Enhanced Rx - Value Formulary $10/40/60 with $0 Pharmacy Deductible Enhanced Rx - Value Formulary $10/40/60 with $150 Pharmacy Deductible Enhanced Rx - Value Formulary $10/40/60 with $250 Pharmacy Deductible Enhanced Rx - Value Formulary $15/30/45 with $0 Pharmacy Deductible Enhanced Rx - Value Formulary $15/30/45 with $150 Pharmacy Deductible Enhanced Rx - Value Formulary $15/30/45 with $250 Pharmacy Deductible Enhanced Rx - Value Formulary $15/30/50 with $0 Pharmacy Deductible Enhanced Rx - Value Formulary $15/30/50 with $150 Pharmacy Deductible Enhanced Rx - Value Formulary $15/30/50 with $250 Pharmacy Deductible Enhanced Rx - Value Formulary $15/40/70 with $0 Pharmacy Deductible Enhanced+ Rx $10/25/40 with $0 Pharmacy Deductible Enhanced+ Rx $10/25/40 with $150 Pharmacy Deductible Enhanced+ Rx $10/25/40 with $250 Pharmacy Deductible Enhanced+ Rx $10/30/50 with $0 Pharmacy Deductible Enhanced+ Rx $10/30/50 with $150 Pharmacy Deductible Enhanced+ Rx $10/30/50 with $250 Pharmacy Deductible Enhanced+ Rx $15/30/45 with $0 Pharmacy Deductible Enhanced+ Rx $15/30/45 with $150 Pharmacy Deductible Enhanced+ Rx $15/30/45 with $250 Pharmacy Deductible Premier Rx $0/10/25/40 with $0 Pharmacy Deductible (Not Marketed) Premier Rx $0/10/25/40 with $150 Pharmacy Deductible (Not Marketed) Premier Rx $0/10/25/40 with $250 Pharmacy Deductible (Not Marketed) Rx Spectrum $10/25/40 with $0 Pharmacy Deductible Rx Spectrum - Value Formulary $15/30/45 with $0 Pharmacy Deductible |
Enhanced Rx $15/20%/30%/40% with $0 Pharmacy Deductible Enhanced Rx $15/20%/30%/40% with $150 Pharmacy Deductible Enhanced Rx $15/20%/30%/40% with $250 Pharmacy Deductible Enhanced Rx $15/30/50% $100 max with $0 Pharmacy Deductible Enhanced Rx $15/30/50% $100 max with $150 Pharmacy Deductible Enhanced Rx $15/30/50% $100 max with $250 Pharmacy Deductible Enhanced Rx $15/40/70 with $250 Pharmacy Deductible Enhanced Rx $20/40/60 with $0 Pharmacy Deductible Enhanced Rx $20/40/60 with $150 Pharmacy Deductible Enhanced Rx $20/40/60 with $250 Pharmacy Deductible Enhanced Rx - Value Formulary $15/20%/30%/40% with $0 Pharmacy Deductible (Withdrawn) Enhanced Rx - Value Formulary $15/20%/30%/40% with $150 Pharmacy Deductible (Withdrawn) Enhanced Rx - Value Formulary $15/20%/30%/40% with $250 Pharmacy Deductible (Withdrawn) Enhanced Rx - Value Formulary $15/40/70 with $150 Pharmacy Deductible Enhanced Rx - Value Formulary $15/40/70 with $250 Pharmacy Deductible Enhanced Rx - Value Formulary $20/40/60 with $0 Pharmacy Deductible (Not Marketed) Enhanced Rx - Value Formulary $20/40/60 with $150 Pharmacy Deductible (Not Marketed) Enhanced Rx - Value Formulary $20/40/60 with $250 Pharmacy Deductible (Not Marketed) Rx Spectrum $15/30/45 with $0 Pharmacy Deductible Rx Spectrum $15/30/45 with $150 Pharmacy Deductible Rx Spectrum - Value Formulary $15/30/45 with $150 Pharmacy Deductible Rx Spectrum - Value Formulary $15/40/70 with $0 Pharmacy Deductible (Withdrawn) Rx Spectrum - Value Formulary $15/40/70 with $150 Pharmacy Deductible (Withdrawn) |
| PPO plans | Enhanced Rx $5/10/25 with $0 Pharmacy Deductible Enhanced Rx $5/10/25 with $150 Pharmacy Deductible Enhanced Rx $10/15/30 with $0 Pharmacy Deductible Enhanced Rx $10/15/30 with $150 Pharmacy Deductible Enhanced Rx $10/15/30 with $250 Pharmacy Deductible Enhanced Rx $10/20/35 with $0 Pharmacy Deductible Enhanced Rx $10/20/35 with $150 Pharmacy Deductible Enhanced Rx $10/20/35 with $250 Pharmacy Deductible Enhanced Rx $10/25/40 with $0 Pharmacy Deductible Enhanced Rx $10/25/40 with $150 Pharmacy Deductible Enhanced Rx $10/25/40 with $250 Pharmacy Deductible Enhanced Rx $10/30/50 with $0 Pharmacy Deductible Enhanced Rx $10/30/50 with $150 Pharmacy Deductible Enhanced Rx $10/30/50 with $250 Pharmacy Deductible Enhanced Rx $10/40/60 with $0 Pharmacy Deductible Enhanced Rx $10/40/60 with $150 Pharmacy Deductible Enhanced Rx $10/40/60 with $250 Pharmacy Deductible Enhanced Rx $15/30/45 with $0 Pharmacy Deductible Enhanced Rx $15/30/45 with $150 Pharmacy Deductible Enhanced Rx $15/30/45 with $250 Pharmacy Deductible Enhanced Rx $15/30/50 with $0 Pharmacy Deductible Enhanced Rx $15/30/50 with $150 Pharmacy Deductible Enhanced Rx $15/30/50 with $250 Pharmacy Deductible Enhanced Rx $15/40/70 with $0 Pharmacy Deductible Enhanced Rx $15/40/70 with $150 Pharmacy Deductible Enhanced Rx - Value Formulary $10/20/35 with $0 Pharmacy Deductible Enhanced Rx - Value Formulary $10/20/35 with $150 Pharmacy Deductible Enhanced Rx - Value Formulary $10/20/35 with $250 Pharmacy Deductible Enhanced Rx - Value Formulary $10/25/40 with $0 Pharmacy Deductible Enhanced Rx - Value Formulary $10/25/40 with $150 Pharmacy Deductible Enhanced Rx - Value Formulary $10/25/40 with $250 Pharmacy Deductible Enhanced Rx - Value Formulary $10/30/50 with $0 Pharmacy Deductible Enhanced Rx - Value Formulary $10/30/50 with $150 Pharmacy Deductible Enhanced Rx - Value Formulary $10/30/50 with $250 Pharmacy Deductible Enhanced Rx - Value Formulary $10/40/60 with $0 Pharmacy Deductible Enhanced Rx - Value Formulary $10/40/60 with $150 Pharmacy Deductible Enhanced Rx - Value Formulary $10/40/60 with $250 Pharmacy Deductible Enhanced Rx - Value Formulary $15/30/45 with $0 Pharmacy Deductible Enhanced Rx - Value Formulary $15/30/45 with $150 Pharmacy Deductible Enhanced Rx - Value Formulary $15/30/45 with $250 Pharmacy Deductible Enhanced Rx - Value Formulary $15/30/50 with $0 Pharmacy Deductible Enhanced Rx - Value Formulary $15/30/50 with $150 Pharmacy Deductible Enhanced Rx - Value Formulary $15/30/50 with $250 Pharmacy Deductible Enhanced Rx - Value Formulary $15/40/70 with $0 Pharmacy Deductible Enhanced+ Rx $10/25/40 with $0 Pharmacy Deductible Enhanced+ Rx $10/25/40 with $150 Pharmacy Deductible Enhanced+ Rx $10/25/40 with $250 Pharmacy Deductible Enhanced+ Rx $10/30/50 with $0 Pharmacy Deductible Enhanced+ Rx $10/30/50 with $150 Pharmacy Deductible Enhanced+ Rx $10/30/50 with $250 Pharmacy Deductible Enhanced+ Rx $15/30/45 with $0 Pharmacy Deductible Enhanced+ Rx $15/30/45 with $150 Pharmacy Deductible Enhanced+ Rx $15/30/45 with $250 Pharmacy Deductible Premier Rx $0/10/25/40 with $0 Pharmacy Deductible Premier Rx $0/10/25/40 with $150 Pharmacy Deductible Rx Spectrum $10/25/40 with $0 Pharmacy Deductible Rx Spectrum - Value Formulary $15/30/45 with $0 Pharmacy Deductible |
Enhanced Rx $15/20%/30%/40% with $0 Pharmacy Deductible Enhanced Rx $15/20%/30%/40% with $150 Pharmacy Deductible Enhanced Rx $15/20%/30%/40% with $250 Pharmacy Deductible (Withdrawn) Enhanced Rx $15/30/50% $100 max with $0 Pharmacy Deductible Enhanced Rx $15/30/50% $100 max with $150 Pharmacy Deductible Enhanced Rx $15/30/50% $100 max with $250 Pharmacy Deductible Enhanced Rx $15/40/70 with $250 Pharmacy Deductible Enhanced Rx $20/40/60 with $0 Pharmacy Deductible Enhanced Rx $20/40/60 with $150 Pharmacy Deductible Enhanced Rx $20/40/60 with $250 Pharmacy Deductible Enhanced Rx - Value Formulary $15/20%/30%/40% with $0 Pharmacy Deductible (Withdrawn) Enhanced Rx - Value Formulary $15/20%/30%/40% with $150 Pharmacy Deductible (Withdrawn) Enhanced Rx - Value Formulary $15/20%/30%/40% with $250 Pharmacy Deductible (Withdrawn) Enhanced Rx - Value Formulary $15/40/70 with $150 Pharmacy Deductible Enhanced Rx - Value Formulary $15/40/70 with $250 Pharmacy Deductible Enhanced Rx - Value Formulary $20/40/60 with $0 Pharmacy Deductible (Not Marketed) Enhanced Rx - Value Formulary $20/40/60 with $150 Pharmacy Deductible (Not Marketed) Enhanced Rx - Value Formulary $20/40/60 with $250 Pharmacy Deductible (Not Marketed) Rx Spectrum $15/30/45 with $0 Pharmacy Deductible Rx Spectrum $15/30/45 with $150 Pharmacy Deductible Rx Spectrum - Value Formulary $15/30/45 with $150 Pharmacy Deductible Rx Spectrum - Value Formulary $15/40/70 with $0 Pharmacy Deductible (Withdrawn) Rx Spectrum - Value Formulary $15/40/70 with $150 Pharmacy Deductible (Withdrawn) |
**All Custom plans with a combined Rx/Medical deductible and out-of-pocket maximum must be certified as either Creditable or Non-Creditable individually. Please contact your Blue Shield account representative for assistance with individual plan certification.
Web resources - Medicare Part D
To learn more about Medicare Part D and how it can affect your Medicare-eligible retirees, please visit:
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Page last updated 10/1/2026
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