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 members whether their current plan is or is not creditable prescription drug coverage by October 15. 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, 2025.
Individual and Family Plans
| Plan type | Creditable plans | Non-creditable plans |
|---|---|---|
| IFP: PPO plans | Blue Shield Platinum 90 PPO Blue Shield Platinum 90 PPO AI-AN Blue Shield Gold 80 PPO Blue Shield Gold 80 PPO AI-AN Blue Shield Silver 70 PPO Blue Shield Silver 70 PPO AI-AN Blue Shield Silver 94 PPO Blue Shield Silver 87 PPO Blue Shield Silver 73 PPO Silver 70 Off Exchange PPO Silver 1750 PPO Silver 2600 HDHP PPO Blue Shield Bronze 60 PPO Blue Shield Bronze 60 PPO AI-AN Blue Shield Bronze 60 HDHP PPO Blue Shield Bronze 60 HDHP PPO AI-AN Blue Shield Minimum Coverage PPO Blue Shield $0 Cost Share PPO AI-AN |
|
| IFP: HMO plans | Blue Shield Platinum 90 Trio HMO Blue Shield Platinum 90 Trio HMO AI-AN Blue Shield Gold 80 Trio HMO Blue Shield Gold 80 Trio HMO AI-AN Blue Shield Silver 70 Trio HMO Blue Shield Silver 70 Trio HMO AI-AN Blue Shield Silver 94 Trio HMO Blue Shield Silver 87 Trio HMO Blue Shield Silver 73 Trio HMO Silver 70 Off Exchange Trio HMO Blue Shield $0 Cost Share Trio HMO AI-AN |
Bronze 7500 Trio HMO |
| IFP: Grandfathered plans* | Shield Spectrum 5000-G* Vital ShieldSM Plus 900 Gen Rx-G Vital ShieldSM 900-G Shield Savings 1800/3600-G |
Active StartSM Plan 35-G BalanceSM Plan 2500-G |
* Underwritten by Blue Shield Life & Health Insurance Company (Blue Shield Life).
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 | 2025: 2024: |
Midsize and Large Group
| Plan type | Creditable plans | Non-creditable plans |
|---|---|---|
| Medicare and Large Group | All Portfolio plans | None** |
**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 10/1/2024
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