--- title: CMS Maintains Creditable Coverage for 2025, New Method for 2026 description: The CMS unveiled the final and draft instructions regarding guidance on the Part D benefit changes introduced by the Inflation Reduction Act of 2022, image: https://blog.nisbenefits.com/hubfs/blog-headers/creditable-coverage-b.jpg --- ![CMS Maintains Creditable Coverage for 2025, New Method for 2026](https://blog.nisbenefits.com/hubfs/blog-headers/creditable-coverage-b.jpg) # CMS Maintains Creditable Coverage for 2025, New Method for 2026 - Home - [Employee Benefit News for School, City and County Employers](https://blog.nisbenefits.com) - CMS Maintains Creditable Coverage for 2025, New Method for 2026 [ Erin Woulfe ](https://blog.nisbenefits.com/author/erin-woulfe) 01/29/2025 [ Health Insurance Solutions](https://blog.nisbenefits.com/topic/health-insurance-solutions), [ Legislative News](https://blog.nisbenefits.com/topic/aca-other-legislative-news) [0 Comments ](https://blog.nisbenefits.com/creditable-coverage-2025-new-method-2026#postComment) 1 Minutes *2 minute read* In April 2024, the Centers for Medicare and Medicaid Services (CMS) unveiled the [Final Part D Redesign Program Instructions](https://www.cms.gov/files/document/final-cy-2025-part-d-redesign-program-instructions.pdf) for calendar year 2025, followed by the [Draft Instructions for 2026](https://www.cms.gov/files/document/draft-cy-2026-part-d-redesign-program-instructions.pdf) for calendar year 2026 on January 10, 2025. These documents provide comprehensive insights and guidance on the Part D benefit changes introduced by the Inflation Reduction Act of 2022 (IRA), significantly affecting the creditable coverage status of employer-sponsored prescription drug plans.   ## **Creditable Coverage** For employers offering prescription drug coverage to Medicare Part D-eligible individuals, it's crucial to inform both the individuals and CMS about the creditable status of their coverage, ensuring it meets or exceeds Medicare Part D standards. [Existing CMS guidance](https://www.cms.gov/medicare/employers-plan-sponsors/creditable-coverage?redirect=/CreditableCoverage/40_CCDisclosure.asp) outlines several methods for determining creditable coverage: - Employers with insured plans should first consult their carriers to confirm the creditable status. - For self-insured plans or when carriers haven't made a determination, a simplified method can be used if the coverage meets specific design criteria. Otherwise, an actuarial method is required.   ## **Part D Redesign Program Instructions for CY 2025** Regarding the Part D Redesign Program for 2025, the CMS initially indicated that the simplified determination method would be phased out due to IRA-induced changes. However, the Final Instructions allow its continued use for 2025, provided the group health plan sponsors are not seeking the retiree drug subsidy.   ## **Draft Part D Redesign Program Instructions for CY 2026** The [Draft Part D Redesign Program Instructions for CY 2026](https://www.cms.gov/files/document/draft-cy-2026-part-d-redesign-program-instructions-fact-sheet.pdf) propose a revised simplified determination method that aligns more closely with the enhanced Part D standard benefit under the IRA. This revision requires coverage to cover, on average, at least 72% of a participant's drug expenses, up from the current 60%, to qualify as creditable. CMS is open to comments on these draft instructions until February 10, 2025, with the final version expected by April 7, 2025. Download the [bulletin](https://blog.nisbenefits.com/hubfs/blog-supporting-docs/bulletin-cms-creditable-coverage-determination.pdf) for more details.   ### **Additional Resource** [CMS’ Part D Improvements webpage](https://www.cms.gov/inflation-reduction-act-and-medicare/part-d-improvements) [![Guide to Restructuring Retiree Benefits](https://no-cache.hubspot.com/cta/default/3325505/49cf7061-b64c-4370-b6e1-d10ec78158b6.png)](https://cta-redirect.hubspot.com/cta/redirect/3325505/49cf7061-b64c-4370-b6e1-d10ec78158b6)   --- #### Tag: [ Health Insurance Solutions](https://blog.nisbenefits.com/topic/health-insurance-solutions) [ Legislative News](https://blog.nisbenefits.com/topic/aca-other-legislative-news) #### Share: - [Follow us on Facebook ](http://www.facebook.com/share.php?u=https://blog.nisbenefits.com/creditable-coverage-2025-new-method-2026) - [Follow us on Twitter ](https://twitter.com/intent/tweet?url=https://blog.nisbenefits.com/creditable-coverage-2025-new-method-2026&text=CMS%20Maintains%20Creditable%20Coverage%20for%202025,%20New%20Method%20for%202026) - 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