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Coordination Of Benefits Basics

Creditable drug coverage

Understand if your drug coverage is considered creditable to know whether you can delay Part D enrollment.

Last Updated: January 29, 2025

Creditable drug coverage is, on average, as good as or better than the basic Part D benefit. You should receive a notice from your employer or plan around September of each year, informing you if your drug coverage is creditable. If you have not received this notice, contact your human resources department, drug plan, or benefits manager. Be aware that this information may not come as a separate piece of mail; it can be included with other materials, such as a plan newsletter.

Several types of plans offer creditable drug coverage, including:

If you are considering delaying Part D Part D, also known as the Medicare prescription drug benefit, is the part of Medicare that provides prescription drug coverage. Part D is offered through private companies either as a stand-alone plan, for those enrolled in Original Medicare, or as a set of benefits included with a Medicare Advantage Plan. Enrollment Enrollment is joining Original Medicare or becoming a member of a Medicare Advantage Plan or Part D plan. because you already have Prescription Drug A prescription drug is a drug that can be obtained only if you have a prescription from a provider. Prescription drugs cannot be bought over the counter.  coverage, make sure to find out if your coverage is considered creditable. Maintaining enrollment in creditable drug coverage means you will not incur a late enrollment penalty (LEP) for delaying Part D enrollment. Additionally, having Creditable Coverage Creditable coverage is used in two different ways. In general, it is coverage that gives you the right to buy or switch health insurance coverage without penalty, restriction, or waiting period. Different types of health insurance have different creditable coverage requirements. For Medigap policies, certain health insurance coverage you had within 63 days of securing a new policy can be used to shorten the waiting period for pre-existing conditions. This type of coverage that shortens the waiting period would be called creditable coverage. For Part D, creditable coverage is prescription drug coverage that is evaluated by an actuary and determined to be as good as or better than the basic Part D benefit. If you have creditable drug coverage, you can delay enrollment without penalty. Medicare Part A and Part B enrollment is NOT affected by prior creditable coverage.  means that if you learn that you are going to lose such coverage and you want Part D coverage, you will have a two-month Special Enrollment Period (SEP) to enroll in a Part D plan.

If you have no drug coverage, or have drug coverage that is not creditable, Part D may help you. Even if you do not take Prescription A prescription is an order for a health care service or drug written by a qualified health care professional.  drugs, it is important to enroll in Part D so that if you later need to access prescriptions you do not face penalties or Gaps in Coverage Gaps in coverage are services or costs that are not covered by Original Medicare, such as vision, dental, and hearing care, as well as deductibles and coinsurance. .

Remember, if you decide to delay enrollment in any part of Medicare Medicare is the federal government health insurance program that provides health care coverage if you are 65 or older, are under 65 and receive Social Security Disability Insurance (SSDI) for 24 months, begin receiving SSDI due to ALS/Lou Gehrig’s Disease, or have End-Stage Renal Disease (ESRD) no matter your age. You can receive health coverage directly through the federal government (see Original Medicare) or through a private company (see Medicare Advantage). , keep a record of your insurance until you enroll in Medicare. You may need this documentation in order to sign up for Medicare later.

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