Creditable Coverage Information for Small Groups

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. These 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, on average, for prescription drugs for individuals covered by the plan in 2019 is 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, on average, for prescription drugs for individuals covered by the plan in 2019 is 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 coverage that is non-creditable may:

1. 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.

Or

2. Purchase a Medicare PDP 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.

Blue Shield Plan Type Creditable Plans

Non-Creditable Plans

Small group (2-100 eligible employees) All plans except those listed in the Non-Creditable Plans column.

For 2019:
Bronze Full PPO Savings 6650 OffEx
Bronze Full PPO Savings 5300/40% OffEx
Bronze Full PPO 6000/65 OffEx
Bronze Full PPO 4500/70 OffEx
Bronze Full PPO 6500/50% OffEx
Bronze Tandem PPO 6500/50% OffEx
Bronze Tandem PPO 4500/70 OffEx
Blue Shield Bronze 60 PPO 6300/75 + Child Dental


For 2020:
Bronze Full PPO Savings 6900 OffEx
Bronze Full PPO Savings 5300/40% OffEx
Bronze Full PPO 6850/65 OffEx
Bronze Full PPO 5000/70 OffEx
Bronze Full PPO 6500/50 OffEx
Bronze Tandem PPO 6850/65 OffEx
Bronze Tandem PPO 5000/70 OffEx
Bronze Tandem PPO 6500/50 OffEx
Blue Shield Bronze 60 PPO 6300/65 + Child Dental

Web Resources - Medicare Part D

To learn more about Medicare Part D and how it can affect your Medicare-eligible retirees, see the following:

Blue Shield of California is a PDP plan with a Medicare contract. Enrollment in Blue Shield of California depends on contract renewal. The Plan is open only to Medicare beneficiaries who are eligible employer group retirees with Part A and/or Part B and who reside in the plan's service area.

Blue Shield of California complies with applicable state laws and federal civil rights laws, and does not discriminate on the basis of race, color, national origin, ancestry, religion, sex, marital status, gender, gender identity, sexual orientation, age, or disability. Blue Shield of California cumple con las leyes estatales y las leyes federales de derechos civiles vigentes, y no discrimina por motivos de raza, color, país de origen, ascendencia, religión, sexo, estado civil, género, identidad de género, orientación sexual, edad ni discapacidad. Blue Shield of California 遵循適用的州法律和聯邦公民權利法律,並且不以種族、膚色、原國籍、血統、宗教、性別、婚姻 狀況、性別認同、性取向、年齡或殘障為由而進行歧視。

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Page last updated: 01/15/2019