How to Make Your Medicare Part D Creditable Determination Friction-Free
Modernizing Compliance for Brokers, TPAs & Employers
If you’re managing employer prescription drug plans, you already know the drill: yearly determination, official notices, audits looming. But too many teams are still stuck in spreadsheets, back-and-forth emails, and manual workflows that take weeks and still carry risk.
At Creditable, we believe that compliance should not be painful. It should be efficient, transparent, and even scalable. Here’s how we help make that happen and why it matters now more than ever.
Why Many Creditable Determinations Are Slipping Through the Cracks
1. It’s a tiny corner of compliance but with huge consequences
The obligation under Centers for Medicare & Medicaid Services (CMS) – to determine whether a prescription drug plan is “creditable” or “non-creditable” under Medicare Part D is highly specialized. Most HR teams don’t have the bandwidth, carriers/TPAs don’t always prioritize it, and it often falls into a catch-all bucket until “that week in November.”
According to our own research:
Thresholds change every year, so what passed last year may not pass this year.
Manual methods (spreadsheets, emails, taped-together workflows) increase risk.
Incorrect determinations expose employees to lifetime penalties if they delay Part D enrollment without creditable coverage.
In short: high stakes, low visibility.
2. Manual workflows = slow, costly, error-prone
Most brokerage/TPA workflows still follow this model:
Collect plan design details (deductibles, copays, tiers)
Plug into a spreadsheet or send to an actuary
Generate a determination memo, draft notices
File documentation for audit
This can take days or weeks. It’s expensive. And frankly, it’s a compliance method that feels like it’s living in 2012.
3. Lack of documentation, audit risk
Compliance isn’t just about passing a test, it’s about being able to prove you passed that test. If a plan is determined wrongly, or notices weren’t sent, the employer might face significant penalties or audits. Many legacy workflows don’t store everything in one place, or lack transparency on how the determination was reached.
How Creditable Makes It Simple — And Scalable
At Creditable we’ve built a platform specifically for this challenge. Here’s how it works, and why it sets a new standard:
Step by step:
Input plan details — Whether you’re a broker, TPA or employer, you simply upload the key plan information: plan type, deductible, copayment schedule, tiers, etc.
creditableInstant evaluation — Our platform applies actuarial-grade logic (in line with CMS regulations) and gives you a determination: “Creditable” or “Non-Creditable” — in seconds, not weeks. creditable
Automated documentation — We generate the official determination report plus notice language that the employer can use (and send) as required.
Data storage & audit readiness — All determinations, version history, plan data and notices live in one central platform. Transparency, documentation, and compliance at your fingertips.
Key benefits:
Speed: Determinations in seconds vs. days.
Accuracy: Built on verified methodology, reducing spreadsheet risk. creditable
Transparency: Clear inputs, clear logic, clear outcomes.
Affordability: No need to budget thousands for actuary fees per plan.
Scalability: One platform, many clients, many plan years — perfect for brokers/TPAs scaling their book.
Why Now Is the Moment to Modernize
With changes on the horizon, including new CMS guidance for the 2026 plan year, the time to streamline is now. Employers and advisors who get ahead of the curve will not only reduce compliance risk but create a competitive advantage.
For a broker or TPA, offering a seamless, tech-driven solution for Part D determinations sends a strong market signal: you’re forward-thinking, you reduce hassle for your clients, and you minimize audit risk.
Three Quick Considerations Before You Proceed
Know your save location – Store all documentation (determination reports, notices, plan data) in a central, secure place - not loose folders.
Designate ownership – Make sure there’s clear ownership between the employer, broker, TPA or carrier on who runs the determination and sends the notice.
Archive historic years – IRS/CMS may ask for past years. Having a searchable archive inside your platform gives you peace of mind.
Ready to See How It Works?
We’d love to show you. If you’re a broker, TPA or employer ready to put compliance on autopilot, book a demo or get started today: joincreditable.com
Because compliance should move at the speed of business - not at the speed of bureaucracy.
About Creditable
Creditable automates Medicare Part D creditable coverage determinations for employer prescription drug plans. We enable brokers, TPAs and HR teams to test each plan for accuracy, generate official documentation, and manage every determination with speed, consistency and confidence. creditable