Creditable Coverage Requirements Under Medicare Modernization Act
for Medicare Part D Eligible Members
A mailing was sent out in October (2018) to all Trust members with medical coverage 64 years of age and older and members who are Medicare eligible. Most prescription drug plans offered through the Trust are "creditable", which means they are equal or better than the standard Medicare Part D plan. A few of the HSA Qualified High Deductible Health Plans offered through the Trust are considered "non-creditable."
The following pieces of information distributed were the Notice of Creditable Coverage, Notice of Non Creditable Coverage and Frequently Asked Questions. Members will get the appropriate creditable or non-creditable letter based on the prescription drug plan in which they are enrolled. You can review or reprint the documents below by clicking on them.
Members who receive a Notice of Non Creditable Coverage should take appropriate action. Depending on how long an individual goes without creditable prescription drug coverage may impact the amount they pay when they join a Medicare Part D plan.
The Medicare Modernization Act (MMA) requires entities (whose policies include prescription drug coverage) to notify Medicare eligible policyholders whether their prescription drug coverage is creditable coverage, which means that the coverage is expected to pay on average as much as the standard Medicare prescription drug coverage. For more information visit CMS.gov.
Medicare beneficiaries may incur a late enrollment penalty (LEP) if there is a continuous period of 63 days or more at any time after the end of the individual's Part D initial enrollment period during which the individual was eligible to enroll, but was not enrolled in a Medicare Part D plan and was not covered under any creditable prescription drug coverage. For more information on creditable coverage and on how an LEP is assessed, please see the Creditable Coverage and Late Enrollment Penalty webpage on CMS.gov.
If a Medicare beneficiary would has been assessed a late enrollment penalty, the may use the Part D Late Enrollment Penalty (LEP) Reconsideration Request Form.