Medicare Part D Notification and Creditable Coverage Reports
For all producers who sell group plans
The Centers for Medicare & Medicaid Services (CMS) released changes to the 2025 standard Medicare Part D prescription drug benefit. They issued a fact sheet that describes the differences, which include the following:
- A standard benefit consisting of annual deductible, initial coverage, and catastrophic coverage
- A lower annual out-of-pocket threshold of $2,000, down from $8,000 in 2024
- A higher annual deductible of $590, up from $545 in 2024
- A Manufacturer Discount Program that replaces the Coverage Gap Discount Program
- Changes to the liability of enrollees, Part D sponsors, manufacturers, and CMS
For producers that sell small group or Preferred Choice plans
Help your group clients understand their responsibilities about disclosing prescription drug coverage and creditable coverage status information.
Creditable coverage reports
CMS requires employers to notify their Medicare-eligible employees and dependents regarding whether the prescription drug coverage pays, on average, as much as the standard Medicare prescription drug coverage.
The following creditable coverage status reports show 2024 health plans when compared to Medicare Part D 2025 threshold amounts. Creditable coverage status means that the health plan’s prescription drug coverage, on average, pays the same as standard Medicare prescription drug coverage.
- Small groups: 2024-2025 Creditable Coverage Status Report
- Preferred Choice groups: 2024-2025 Creditable Coverage Status Report
Disclosure forms
Federal law also requires employer groups to notify CMS if their prescription drug coverage for Medicare beneficiaries is creditable. CMS requires employer groups to submit a Creditable Coverage Disclosure form each year or whenever any change is made that could affect whether the drug coverage offered is creditable.
Copy the appropriate message below and share with your clients.
For businesses with a small group plan
Dear [CLIENT],
I want to remind you of two important actions you should take as an employer about prescription drug coverage.
- Tell your Medicare-eligible employees: The Centers for Medicare & Medicaid Services (CMS) requires employers to let their Medicare-eligible employees and dependents know whether the prescription drug coverage they have pays on average as much as the standard Medicare prescription drug coverage.
- Tell CMS about the creditable status of your prescription drug coverage: Federal law requires you to report the creditable status of your prescription drug plan to CMS by submitting a Creditable Coverage Disclosure form each year or whenever any change is made that could affect whether the drug coverage offered is creditable.
Where do you find the creditable status of your prescription drug coverage?
Creditable coverage means that the health plan’s prescription drug coverage, on average, pays the same as or better than standard Medicare prescription drug coverage. Premera posts this report online:
More information
For more information on Medicare Part D Notification and Disclosure to CMS requirements, visit cms.gov for:
For businesses with 51+ employees on a Preferred Choice plan
Dear [CLIENT],
I want to remind you of two important actions you should take as an employer about prescription drug coverage.
- Tell your Medicare-eligible employees: The Centers for Medicare & Medicaid Services (CMS) requires employers to let their Medicare-eligible employees and dependents know whether the prescription drug coverage they have pays on average as much as the standard Medicare prescription drug coverage.
- Tell CMS about the creditable status of your prescription drug coverage: Federal law requires you to report the creditable status of your prescription drug plan to CMS by submitting a Creditable Coverage Disclosure form each year or whenever any change is made that could affect whether the drug coverage offered is creditable.
Where do you find the creditable status of your prescription drug coverage?
Creditable coverage means that the health plan’s prescription drug coverage, on average, pays the same as or better than standard Medicare prescription drug coverage.
This report is posted online for Premera Blue Cross and Premera Blue Cross HMO plans:
More information
For more information on Medicare Part D Notification and Disclosure to CMS requirements, visit cms.gov for: