If you offer prescription drug coverage through a group health plan, Medicare regulations require you to inform CMS and Medicare-eligble employees (sometimes retirees) annually at case install or renewal within 60 days window whether their employer-sponsored coverage is considered “creditable” under Medicare guidelines.

Coverage is considered creditable if it meets or exceeds the value of the standard Medicare Part D prescription drug plan.

It’s important to note that pharmacy plans within a high-deductible health plan (HSA-compatible) can be either creditable or non-creditable, depending on whether Medicare is the primary or secondary payer.

This guide highlights Medical plans that are classified as non-creditable. Any plans not listed in this guide are considered creditable.

Anthem Blue Cross

Non-Creditable Plans:

• Anthem Link Virtual First High Performance EPO 6000/50/75/9100

Blue Shield of California

All Blue Shield of California Large Group plans are considered creditable for the 2025 plan year.

Health Net

Non-Creditable Plans:

• P 30/15/50NF VF/E/M2/BC/NS/BGS/LAN/I50

All Other Large Group Plans:

• Creditable if Medicare is Secondary and Non-Creditable if Medicare is Primary

Kaiser Permanente

Kaiser Permanente plans are often customized. Each plan should be tested to determine whether it is Medicare creditable.

Contact your W&B representative to request verification of prescription coverage and to determine if it is actuarially equivalent to standard prescription drug coverage under Medicare Part D.

MediExcel Health Plan

All MediExcel Large Group plans are considered creditable for the 2025 plan year.

Sharp Health Plan

HDHP NG 5 L (Creditable if Medicare is Primary and Non-Creditable if Medicare is Primary).

Total Benefit Solutions

All Total Benefit Solutions Large Group plans are considered creditable for the 2025 plan year.

UnitedHealthcare

Creditable Status will depend on several factors:

• In-network Deductible
• In-network Out-of-Pocket Maximum
• In-network Copays and/or Coinsurance
• Preventive Drug List (Core or Expanded, if applicable)
• Employer contribution for HRA plans

To determine Creditable/Non-Creditable status refer to UHC’s Medicare Part D Creditable Coverage Lookup Tool or contact Creditable.Coverage@optum.com.

Western Health Advantage

All Western Health Advantage Large Group plans are considered creditable for the 2025 plan year.