With the October 15 Medicare Part D notice deadline behind us, it’s time to start preparing for 2026 Creditable Coverage testing. IMPORTANT CHANGES have been made to next year’s testing parameters.
In 2026, the Simplified Determination testing parameters will require a prescription plan sponsor to cover 72% of its plan members’ prescription drug costs – up from 60% in past years. This means that prescription drug plans that were creditable in past years may not be creditable in 2026.
While there is no penalty for a plan not being deemed creditable under these rules, any plan member who remains on a non-creditable prescription plan and who does not enroll in a Medicare Part D plan when first eligible to do so will pay a premium penalty when enrolling later.
Because of this change, it is imperative that group health plans test their 2026 prescription plan benefits against the Medicare Part D 2026 testing criteria and provide timely notices to their employees of the test results. As in the past, MedBen offers testing and notice distribution services. Please contact your Account Management Team for details. If you have already purchased testing services from us, MedBen will automatically have your 2026 prescription benefits tested to the new standard and update you on the results.
Remember, Medicare Part D testing must be completed each year. MedBen clients can get additional information about this coverage change by contacting their Account Management team.