Sarah Borders January 29, 2026 1 min read

Reporting Creditability to CMS When the New Plan Year Begins

Purpose:

  • Within 60 days of the start of each new medical plan year, ALL employers must notify the Centers for Medicare and Medicaid Services (CMS) whether their prescription drug plan options are creditable and/or non-creditable.
  • This 60-day deadline is reduced to 30 days if prescription drug creditability changes or the plan terminates. So, calendar year plans must report by March 2 (or by January 30 if creditability changed or the plan terminated).

Applies To:

  • Employers of any size sponsoring a fully insured, self-insured, or level-funded medical plan with prescription drug coverage.
  • This appears to include HRAs that include reimbursement of prescription drug costs, and ICHRAs that are not just reimbursing insurance premiums but also reimburse prescription drug costs.

Additional Information:

Employers must submit their creditable/non-creditable status via the CMS Creditable/Non-Creditable web form.

Penalties for Non-Compliance:

There is no specific penalty to the employer for not submitting this reporting to CMS. However, it is easy to do and takes very little time, so demonstrating good faith compliance is encouraged.

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Sarah Borders

Principal, Benefits Compliance Solutions. Sarah has spent the last 15 years in the employee benefits industry, has numerous designations and serves on NAHU’s Employer Working Group Subcommittee and is an active board member of Austin AHU. She recently stepped down as Vice President of Benefits Compliance at one of the nation's largest brokerage firms to start her own compliance consulting practice. Her designations include an active license with the Texas Department of Insurance, CEBS (Certified Employee Benefits Specialist), Certified Health Care Reform Professional, HIPAA certification and Health Care Service Associate. She holds an MBA from Texas A&M Corpus Christi and a BA from University of Incarnate Word. Her consulting firm, Benefits Compliance Solutions, partners with employers to identify unknown risks and avoid hundreds of thousands of dollars in fines and lawsuits from failure to comply with their healthplan obligations.

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