Under the Medicare Modernization Act (MMA), applicable entities must notify both CMS and Medicare-eligible plan participants whether their prescription drug coverage is considered creditable. Generally, creditable coverage is defined as coverage that is expected to pay, on average, as much as the standard Medicare prescription drug coverage. To determine the status of each prescription drug plan design offered, plans can use two computational methods for creditable coverage determinations: the simplified determination method or the actuarial analysis method. To meet the compliance requirements of this rule, plans should calculate their creditability annually and provide the appropriate notice to eligible plan participants.

This will require plans to test all prescription drug plan design options, often testing the least rich prescription drug coverage first.

If your plan needs compliance assistance for Medicare Creditable Coverage determinations and plan participant notice(s):