Under §423.56(a) of the final regulation, coverage is creditable if the actuarial value of the coverage equals or exceeds the actuarial value of standard prescription drug coverage under Medicare Part D, as demonstrated through the use of generally accepted actuarial principles and in accordance with CMS actuarial ...
What makes a prescription plan creditable?
A group health plan's prescription drug coverage is considered creditable if its actuarial value equals or exceeds the actuarial value of standard Medicare Part D prescription drug coverage. Prescription drug coverage that does not meet this standard is called “non-creditable.”Sep 12, 2018
What is Medicare creditable prescription drug coverage?
Medicare defines “creditable coverage" as coverage that is at least as good as what Medicare provides. Therefore, creditable drug coverage is as good as or better than Medicare Part D.
How do I prove Medicare Part D creditable coverage?
The Notice of Creditable Coverage works as proof of your coverage when you first become eligible for Medicare. Those who have creditable coverage through an employer or union receive a Notice of Creditable Coverage in the mail each year. This notice informs you that your current coverage is creditable.
What qualifies as creditable coverage?
Creditable coverage is a health insurance, prescription drug, or other health benefit plan that meets a minimum set of qualifications. Types of creditable coverage plans include group and individual health plans, and student health plans, as well as a variety of government-sponsored or government-provided plans.
What is not considered creditable coverage?
Non-creditable coverage: A health plan's prescription drug coverage is non-creditable when the amount the plan expects to pay, on average, for prescription drugs for individuals covered by the plan in the coming year is less than that which standard Medicare prescription drug coverage would be expected to pay.Oct 1, 2021
What entities are required to provide a disclosure of creditable coverage status to CMS?
Group health plan sponsors are required to disclose to CMS whether their prescription drug coverage is creditable or non-creditable. This disclosure is required regardless of whether the health plan's coverage is primary or secondary to Medicare.Jan 18, 2022
Who provides a letter of creditable coverage?
previous insurance carrier
A certificate of Creditable Coverage (COCC) is a document provided by your previous insurance carrier that proves that your insurance has ended. This includes the name of the member to whom it applies as well as the coverage effective date and cancelation date.Jul 12, 2018
Who should receive the Medicare Part D creditable coverage notice?
Who Must Receive the Notice? The notice must be provided to all Medicare-eligible individuals who are covered under, or eligible for, the sponsor's prescription drug plan, regardless of whether the plan pays primary or secondary to Medicare.
Is Express Scripts creditable coverage?
Enroll in Express Scripts Medicare By selecting this option you are choosing to enroll in Express Scripts Medicare, the State Health Plan's Medicare prescription drug program. This coverage is considered creditable coverage.
Is Marketplace considered creditable coverage?
Marketplace coverage isn't creditable coverage for Parts A and B because it's not required to be as good as Original Medicare. This means that you'll need to pay penalties after the first 12 months if you delay coverage.Nov 2, 2021
Is a Medicare Advantage plan considered creditable coverage?
Medicare Advantage plans must offer benefits that are at least as comprehensive as Medicare Parts A and B. Therefore, all Medicare Advantage plans have creditable coverage.Jan 20, 2022