Creditable and non-creditable coverage

Under regulations issued by the Centers for Medicare & Medicaid Services (CMS), Medicare Part D-eligible individuals must be notified whether their current coverage is "creditable prescription drug coverage" each year. The following are definitions of creditable and non-creditable coverage:

  • Creditable coverage: A health plan's prescription drug coverage is creditable when the amount the plan expects to pay for prescription drugs for individuals covered by the plan in the coming year is, on average, the same or more than what standard Medicare prescription drug coverage would be expected to pay.
  • Non-creditable coverage: A health plan's prescription drug coverage is non-creditable when the amount the plan expects to pay for prescription drugs for individuals covered by the plan in the coming year is, on average, less than that which standard Medicare prescription drug coverage would be expected to pay.

Employers must notify Medicare-eligible members whether their current plan is or is not creditable prescription drug coverage by October 15. Members in Blue Shield plans that have been determined as creditable do not need to do anything if they're satisfied with the drug coverage they have through these plans.

Members in Blue Shield plans that have been determined to have non-creditable coverage may do one of the following:

  • Do nothing and keep their current coverage. If they choose this option, they are not purchasing a Medicare Prescription Drug Plan (PDP) and may incur further late enrollment penalties if they choose to purchase a Medicare PDP in the future. There are no forms to fill out for this choice.
  • Purchase a Medicare Prescription Drug Plan during the next Annual Election Period. The late enrollment penalty will apply because the member's current plan is not creditable, and the employee did not choose to enroll in a Medicare PDP when they first became eligible. Within 63 days of enrolling in a Medicare PDP, employees must have the prescription drug coverage removed from their current plan per federal law.

The list below denotes which Blue Shield of California plans offer creditable prescription drug coverage and which do not. Effective January 1, 2025.

Individual and Family Plans

Plan type Creditable plans Non-creditable plans
IFP: PPO plans Blue Shield Platinum 90 PPO 
Blue Shield Platinum 90 PPO AI-AN 
Blue Shield Gold 80 PPO
Blue Shield Gold 80 PPO AI-AN 
Blue Shield Silver 70 PPO 
Blue Shield Silver 70 PPO AI-AN 
Blue Shield Silver 94 PPO 
Blue Shield Silver 87 PPO 
Blue Shield Silver 73 PPO
Silver 70 Off Exchange PPO 
Silver 1750 PPO  
Silver 2600 HDHP PPO
Blue Shield Bronze 60 PPO
Blue Shield Bronze 60 PPO AI-AN
Blue Shield Bronze 60 HDHP PPO 
Blue Shield Bronze 60 HDHP PPO AI-AN
Blue Shield Minimum Coverage PPO
Blue Shield $0 Cost Share PPO AI-AN
 
IFP: HMO plans Blue Shield Platinum 90 Trio HMO 
Blue Shield Platinum 90 Trio HMO AI-AN 
Blue Shield Gold 80 Trio HMO
Blue Shield Gold 80 Trio HMO AI-AN 
Blue Shield Silver 70 Trio HMO 
Blue Shield Silver 70 Trio HMO AI-AN 
Blue Shield Silver 94 Trio HMO  
Blue Shield Silver 87 Trio HMO  
Blue Shield Silver 73 Trio HMO 
Silver 70 Off Exchange Trio HMO 
Blue Shield $0 Cost Share Trio HMO AI-AN  
Bronze 7500 Trio HMO
IFP: Grandfathered plans* Shield Spectrum 5000-G*
Vital ShieldSM Plus 900 Gen Rx-G
Vital ShieldSM 900-G
Shield Savings 1800/3600-G
Active StartSM Plan 35-G
BalanceSM Plan 2500-G

* Underwritten by Blue Shield Life & Health Insurance Company (Blue Shield Life).

Medicare Supplement

Plan type Creditable plans Non-creditable plans
Medicare Supplement plans None Plan H Plus Rx (closed plan)
Plan I Plus Rx (closed plan)
Golden Coronet Senior Plus Rx (closed plan)
Coronet Senior Plus Rx (closed plan)

Small Business Plans

Plan type Creditable plans Non-creditable plans
Small Business Plans All plans except those listed in the non-creditable plans column

2025:
Bronze Full PPO 4500/65 OffEx
Bronze Tandem PPO 4500/65 OffEx
Bronze Full PPO 7500/65 OffEx
Bronze Tandem PPO 7500/65 OffEx
Bronze Access+ HMO 7000/70 OffEx
Bronze Local Access+ HMO 7000/70 OffEx
Bronze Trio HMO 7000/70 OffEx
Silver Access+ HMO 2300/70 OffEx
Silver Local Access+ HMO 2300/70 OffEx
Silver Trio HMO 2300/70 OffEx
Silver Access+ HMO 2750/70 OffEx
Silver Local Access+ HMO 2750/70 OffEx
Silver Trio HMO 2750/70 OffEx
Virtual: Bronze Tandem PPO 7500/75 OffEx
Bronze Full PPO 6850/55 OffEx
Bronze Tandem PPO 6850/55 OffEx
Bronze Full PPO 6250/65 OffEx
Bronze Tandem PPO 6250/65 OffEx
Blue Shield Bronze 60 PPO 6300/60 + Child Dental 

2024:
Bronze Full PPO 7500/65 OffEx
Bronze Tandem PPO 7500/50 OffEx
Virtual: Bronze Tandem PPO 7500/75 OffEx
Bronze Trio HMO 7000/70 OffEx
Blue Shield Bronze Trio HMO 7000/70 + Child Dental
Bronze Access+ HMO (R) 7000/70 OffEx
Bronze Local Access+ HMO (R) 7000/70 OffEx
Bronze Tandem PPO 5500/65 OffEx

Midsize and Large Group

Plan type Creditable plans Non-creditable plans
Medicare and Large Group All Portfolio plans None**

**All Custom plans with a combined Rx/Medical deductible and out-of-pocket maximum must be certified as either Creditable or Non-Creditable individually. Please contact your Blue Shield account representative for assistance with individual plan certification.

Web resources - Medicare Part D

To learn more about Medicare Part D and how it can affect your Medicare-eligible retirees, please visit:

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Page last updated 10/1/2024

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