Part D Creditable Coverage determinations shouldn’t require spreadsheets, guesswork, or last-minute scrambling during open enrollment. Yet every year, brokers and TPAs lose time and take on risk because this critical compliance task is buried in outdated workflows. With new CMS changes on the horizon for 2026, there’s never been a better time to modernize. Creditable makes Medicare Part D determinations fast, accurate, and fully documented — giving employers peace of mind and advisors a competitive edge.

When it comes to employer-sponsored health coverage, the way your plan is structured—whether fully insured, level-funded, or self-funded—can change everything from cost and flexibility to compliance responsibility. Each option fits a different type of employer, but all share one thing in common: the need for accurate Medicare Part D Creditable Coverage Determinations.

This week, we’re breaking down how each funding model works, which employers they’re best suited for, and what you need to know to stay compliant under CMS’s tightening 2026 standards.

With CMS raising the creditable coverage threshold from 60% to 72% in 2026, employer prescription drug plans face a tricky transition. Plans that pass in 2025 may fail the following year. Our latest blog breaks down the key risks, at-risk plan designs, and a step-by-step playbook to keep your plans compliant through the 2025–2026 shift.

2026 is bringing major CMS rule changes that could leave many employer prescription drug plans non-creditable. With the simplified determination threshold jumping from 60% to 72%, and richer Part D benefits raising the bar, plans that once passed may now fall short. Employers, brokers, and HR teams need to prepare now — or risk compliance issues and penalties for their employees.

Not sure how to send Part D creditable coverage notices? This step-by-step guide breaks down exactly what employers need to do before the October 15 deadline, so you can stay compliant and protect your Medicare-eligible employees.

Mid-year plan changes can quietly impact your group’s Medicare Part D creditable coverage status, yet many HR teams and brokers don’t realize it. Learn what triggers a re-test, how to stay compliant, and how to handle plan updates the right way.

In 2026, CMS is raising the actuarial threshold for creditable coverage from 60% to 72%, a change that could impact whether your group drug plan still qualifies under Medicare Part D. This post breaks down what’s changing, why it matters for employers and advisors, and how to stay compliant well before the deadline.

Employers offering health coverage to Medicare-eligible employees must determine each year whether their prescription drug coverage is creditable. This brief explains what creditable coverage means, why annual testing and employee notices matter for compliance, and how employers can avoid penalties by staying proactive.

As more employees become eligible for Medicare, employers must adapt their benefits strategies. This post explores key trends in Medicare and Part D coverage—like integration with employer plans, rising costs, and a shift toward preventative care—that will shape the future of employee benefits.

Clear communication about Part D creditability helps employees avoid Medicare penalties and make informed coverage decisions. This post shares best practices for employers to deliver timely, transparent, and supportive messaging around prescription drug coverage.

Integrating Part D creditability technology into your benefits administration system helps employers stay compliant, minimize errors, and save time. This post outlines how technology like our Part D Credibility platform can streamline annual verification and support employee communication.

Brokers play a key role in protecting clients from costly Medicare Part D penalties by helping them determine whether their prescription drug coverage is creditable. This post explores how brokers can use tools and education to simplify the process and elevate the value they provide to clients.

Choosing between Medicare Part D and employer-sponsored prescription drug coverage can be confusing for employees nearing Medicare eligibility. This post highlights the key differences between the two, explains how creditability impacts enrollment decisions, and offers guidance to help employers support their teams in making the best choice.

Late enrollment penalties for Medicare Part D can create long-term financial burdens for employees if their prescription drug coverage isn’t creditable. This post explains how these penalties work, how they’re calculated, and what employers can do to help their teams avoid them—ensuring a smoother, penalty-free transition to Medicare.

When employees turn 65 and become eligible for Medicare, employers play a crucial role in helping them make informed decisions—especially about Medicare Part D prescription drug coverage. This post breaks down how Part D works, what creditable coverage means, and how employers can support their employees in avoiding late enrollment penalties and ensuring a smooth transition.

Understanding the Actuarial Method for Determining Part D Creditable Coverage — And How We Simplify It

The actuarial method is the gold standard for determining whether an employer’s prescription drug plan meets Medicare Part D’s creditable coverage requirements. Traditionally, this process involves complex statistical comparisons and actuarial expertise — but now, it doesn’t have to be complicated.

Our platform uses sophisticated actuarial algorithms to automatically compare your clients’ plans against Medicare’s standards, delivering fast, compliant creditability determinations in seconds. No manual calculations, no uncertainty — just instant, CMS-compliant reporting that protects your business and your clients.

With creditable, you can ensure every Part D determination is accurate, defensible, and effortless.

Debunking the Top 5 Myths About Part D Creditable Coverage

Misunderstandings about Medicare Part D creditable coverage can lead to costly mistakes for both employers and employees. In this post, we break down the five most common myths — from the belief that all employer plans are automatically creditable to the misconception that deadlines don’t matter. By setting the record straight, we help ensure you stay compliant, avoid penalties, and support your employees in making informed healthcare decisions.

Avoid Costly Mistakes: Common Errors in Determining Part D Creditable Coverage

Determining whether your health plan is creditable for Medicare Part D is crucial — but it’s easy to make mistakes that could lead to penalties and confusion for your employees. In this post, we break down the most common errors employers make, including failing to review coverage annually, missing employee notifications, relying on outdated information, and ignoring critical compliance deadlines. By understanding and avoiding these pitfalls, you can protect your employees and keep your organization compliant with Medicare requirements.

How Part D Creditable Coverage Impacts Medicare Beneficiaries

For individuals approaching Medicare eligibility, understanding Part D creditable coverage is essential. Having creditable coverage helps beneficiaries avoid costly late enrollment penalties, simplifies the transition to Medicare, and provides greater flexibility in choosing when to enroll. In this post, we break down how knowing your creditable coverage status can protect you from unnecessary costs and make the move to Medicare much smoother.

The Importance of Timing When Determining Part D Creditable Coverage

When it comes to Part D creditability, timing is everything. Delays in determining and notifying employees about their coverage can lead to costly lifetime penalties, legal risks, and frustrated employees. In this post, we explain why staying on schedule is crucial — from avoiding Medicare penalties to maintaining employee trust — and share simple strategies, like using automated tools, to help your organization stay compliant and ahead of deadlines.