Medicare Creditable Coverage Checker
Walk through whether prior drug coverage counted — the question that decides whether a Part D late enrollment penalty applies at all. We also tell you whether the same coverage did anything for Part B, which is a completely separate answer.
Nothing you enter leaves your browser — every calculation runs on your device
1 What drug coverage did they have before Part D?
Pick the one they held most recently. The rest of the questions adapt to it.
2 Dates
Type straight through — pasting works too.
Leave blank if they still have it.
When the drug plan begins.
3 Anything that cancels the penalty outright?
Turning 65 resets any prior Part D penalty.
Result
Pick a coverage type and enter the dates to see the verdict.
Estimate only, based on CY2026 figures (the 63-day rule and CMS creditable coverage guidance). This is not an official determination. MedicareCopilot is not affiliated with or endorsed by CMS, Medicare, the Social Security Administration, or any government agency — official amounts and eligibility determinations are made by SSA and CMS. This tool provides general information only and is not medical, legal, or tax advice. Figures last verified 2026-07-27.
One question, two very different answers
Creditable coverage decides the Part D penalty. Active employment decides the Part B window. MedicareCopilot tracks both for every client, alongside CRM, quoting, enrollment, and commission tracking.
What creditable coverage means
Prescription drug coverage is creditable when it is expected to pay, on average, at least as much as Medicare's standard Part D benefit. If coverage was creditable, no Part D late enrollment penalty accrues for the months it was held — however long the beneficiary waited to join a Part D plan.
The penalty is triggered by a gap of 63 or more continuous days without creditable coverage after the Initial Enrollment Period closes. Below 63 days, nothing is owed.
For 2026 the bar moved. Because the Inflation Reduction Act made the standard Part D benefit richer — the out-of-pocket cap is $2,100 in 2026 — CMS finalised a revised simplified determination methodology. A plan must now be designed to pay at least 72% of participants' drug costs, up from 60%. A plan that was creditable in 2025 is not automatically creditable in 2026, and "we checked last year" is no longer a safe answer.
Only the plan sponsor can make this determination, and they are required to disclose it in a notice issued every year before 15 October. That notice is the document that settles a penalty dispute later, so it belongs in the client file.
Finally, and separately: creditable drug coverage says nothing about Part B. COBRA and retiree coverage can both be creditable for Part D while doing nothing at all to protect a Part B delay. The 8-month Part B Special Enrollment Period runs from the end of active employment.
Common questions
What is creditable coverage for Medicare Part D?
Prescription drug coverage is creditable when it is expected to pay, on average, at least as much as Medicare's standard Part D benefit. If your coverage was creditable, no Part D late enrollment penalty accrues for the months you held it.
Only the plan sponsor can make this determination, and they must tell you in an annual notice issued before 15 October each year.
Did the creditable coverage rules change for 2026?
Yes. CMS finalised a revised simplified determination methodology for 2026: a plan must now be designed to pay at least 72% of participants' prescription drug costs, up from 60%.
The change follows from the Inflation Reduction Act making the standard Part D benefit richer, most visibly the $2,100 out-of-pocket cap. The practical consequence is that some employer plans that were creditable in 2025 are not creditable in 2026, so last year’s notice is not a safe answer.
Does COBRA count as creditable coverage?
For Part D, it depends on the underlying plan — COBRA drug coverage is creditable if the plan it continues was creditable. Ask the benefits administrator for the notice.
For Part B, COBRA does nothing at all. It does not open a Special Enrollment Period, and the 8-month Part B window runs from the end of active employment rather than from the end of COBRA. Waiting for COBRA to run out before enrolling in Part B is the most expensive common Medicare mistake.
Is VA or TRICARE coverage creditable?
Yes. VA health care, TRICARE, TRICARE for Life, FEHB, and Indian Health Service drug coverage are all creditable for Part D purposes, so no penalty accrues while you hold them.
None of them opens a Part B Special Enrollment Period, and TRICARE for Life additionally requires you to keep Part B — letting it lapse ends the TRICARE coverage.
Does a prescription discount card count?
No. Prescription discount cards and pharmacy savings programmes are never creditable coverage, regardless of how much they save.
They are not insurance. Clients frequently believe otherwise, which is how a penalty accrues for years without anyone noticing.
How long a gap triggers the Part D penalty?
A continuous gap of 63 days or more without creditable drug coverage, after your Initial Enrollment Period ends, triggers the Part D late enrollment penalty. A gap shorter than that triggers nothing at all.
The gap matters even if the earlier coverage was creditable — creditable coverage protects the months it was held, not the months after it ends.
What if I cannot find the creditable coverage notice?
Ask the former employer’s benefits administrator in writing for the Medicare Part D Notice of Creditable Coverage, naming the plan and the coverage dates. Sponsors are required to issue this notice annually.
If a penalty has already been assessed and the notice later shows the coverage was creditable, the Part D penalty can be challenged through reconsideration, generally within 60 days of the notice.