What is Medicare Creditable Coverage?
Medicare is a federal health insurance program for people age 65 and older, as well as people with certain disabilities. Medicare Part D is the prescription drug coverage part of Medicare.
Medicare creditable coverage is prescription drug coverage that is expected to pay, on average, at least as much as Medicare’s standard prescription drug coverage. If you have creditable prescription drug coverage, you may be able to delay enrolling in Medicare Part D without penalty.
There are several benefits to having Medicare creditable coverage:
- You may be able to delay enrolling in Medicare Part D without penalty. This is important because if you go 63 days or more in a row without creditable coverage or other Medicare drug coverage, you may have to pay a late enrollment penalty if you sign up for Medicare drug coverage later.
- You may be able to keep the prescription drug coverage you already have. If you have creditable prescription drug coverage through your employer or another group health plan, you may be able to keep that coverage instead of enrolling in Medicare Part D.
- You may have more choices in prescription drug coverage. If you have creditable prescription drug coverage, you may be able to choose from a variety of different plans, including stand-alone Part D plans and Medicare Advantage plans that include prescription drug coverage.
Here are some examples of Medicare creditable coverage:
- Prescription drug coverage from your current or former employer or union
- TRICARE
- Indian Health Service
- VA
- Individual health insurance coverage that meets Medicare’s standards for creditable coverage
To find out if your prescription drug coverage is creditable, you can contact your plan or check Medicare’s website.
If you have Medicare creditable coverage, you should compare plans to make sure you are getting the best coverage for your needs. You should also consider when you want to enroll in Medicare Part D.
If you are not sure what to do, you can contact Medicare for help.
Here are some additional tips for dealing with Medicare creditable coverage:
- Review your coverage annually. Your employer or other group health plan may change the level of prescription drug coverage they offer each year. It is important to review your coverage annually to make sure it is still creditable and meets your needs.
- Keep track of your creditable coverage. If you leave your job or change health plans, be sure to keep track of your creditable coverage. This will help you avoid having to pay a late enrollment penalty if you sign up for Medicare Part D later.
- Talk to a Medicare counselor. If you have questions about Medicare creditable coverage or Medicare Part D, you can talk to a Medicare counselor. Medicare counselors can help you understand your options and choose the best coverage for your needs.
You can find a Medicare counselor in your area by calling 1-800-MEDICARE (1-800-633-4227).
