Medicare Part D Creditable Coverage impact on UnitedHealthcare commercial plans
Changes were made to the Medicare Part D plan design for 2025, impacting creditable coverage standards.
The Medicare Modernization Act requires entities offering prescription drug coverage to notify Medicare eligible policyholders whether their prescription drug coverage is creditable coverage, which means that the prescription drug coverage offered by a group health plan is expected to pay, on average, at least as much as the standard Medicare Part D drug coverage.
For more detail refer to Medicare Part D Creditable Coverage on uhc.com.
Changes impacting creditable coverage for 2025
- For 2025, changes were made to the Medicare Part D plan design, including a $2,000 out-of-pocket limit on medications
- These changes have increased the richness of the standard Medicare Part D benefit, setting a higher minimum standard that group health plans will need to meet for their prescription drug coverage to be considered creditable
- In order to maintain creditable status for 2025, group health plans may need to increase the actuarial value of their plan’s pharmacy benefits
To prepare for the change, UnitedHealth Group actuaries have analyzed the impact of the 2025 creditable coverage standards.
- The 2025 Creditable Coverage Test Look Up Tool is available as of June 30
- This tool will allow a plan to be tested against the 2025 Medicare Part D parameters to determine if the plan is creditable
Creditable coverage responsibilities
- UnitedHealthcare must disclose whether the plan’s coverage passes or fails the minimum set of qualifications via the testing tools on the website Medicare Part D Creditable Coverage on uhc.com
- Employers must understand and communicate the creditable coverage status of their plans to their employees and to CMS annually
- Members on non-creditable coverage may pay a higher premium on a permanent basis once they become 65 years old and enroll in Medicare Part D
Please contact your broker or UnitedHealthcare representative if you have questions.
