a) The prescription drug coverage has no annual benefit maximum benefit or a maximum annual benefit payable by the plan of at least $25,000, or
b) The prescription drug coverage has an a expectation that the amount payable by the plan will be at least $2,000 annually per Medicare eligible individual.
c) [Health plans with integrated healthcare features, such as dental and medical] For entities that have integrated health coverage, the integrated health plan has no more than a $250 deductible per year, has no annual benefit maximum or a maximum annual benefit payable by the plan of at least $25,000 and has no less than a $1,000,000 lifetime combined benefit maximum.
(An integrated plan is any plan of benefits that is offered to a Medicare eligible in where the prescription drug benefit is combined with other coverage offered by the entity (i.e., medic dental, vision, etc.) and the plan has all of the following plan provisions:
1) a combined plan year deductible for all benefits under the plan,
2) a combined annual benefit maximum for all benefits under the plan, and
3) a combined lifetime benefit maximum for all benefits under the plan.
A prescription drug plan that meets the above parameters is considered an integrated plan for the purpose of using the simplified method and would have to meet steps 1, 2, 3 and 4(c) of the simplified method If it does not meet all of the criteria, then it is not considered to be an integrated plan and would have to meet steps 1, 2, 3 and either 4(a) or 4(b).)"
Important: Keep a copy of the "creditable coverage" notice
from your employer that specifically states that you have creditable
If you join a Medicare drug plan after you are first eligible, you'll need to provide this letter of creditable coverage as proof - or otherwise face the late-enrollment penalty.
Even if you provide the letter of creditable coverage, your newly-chosen Medicare Part D drug plan may contact you for additional information.
The Medicare Part D plan will determine whether you have had continuous creditable drug coverage and send this information to Medicare.
If your current employer/union coverage is not at least as good as the standard Medicare drug coverage (non-creditable), you may be able to:
If you drop your employer/union coverage, you may not be able to get it back. You may not be able to drop your employer/union drug coverage without also dropping your employer/union health coverage.
In some cases, employers or unions have rules that say you cannot have both a Medicare drug plan and your employer/union plan. Your current coverage may end for you and your dependents.
You should talk to your employer/union and/or the benefits administrator about all of your options.
If you are covered under COBRA, you should check with your former employer/union or the benefits administrator to see if the coverage is creditable.Workers' compensation is not considered creditable coverage.
If you didn't receive a creditable coverage notice:
You must request in writing a copy of the creditable coverage notice from your employer/union. You must send it by certified/registered mail. Keep a copy of your letter for your records.
"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 these entities, there are two disclosure requirements:
1. The first disclosure requirement is to provide a written disclosure notice to all Medicare eligible individuals annually who are covered under its prescription drug plan, prior to October 15th each year and at various times as stated in the regulations, including to a Medicare eligible individual when he/she joins the plan. This disclosure must be provided to Medicare eligible active working individuals and their dependents, Medicare eligible COBRA individuals and their dependents, Medicare eligible disabled individuals covered under your prescription drug plan and any retirees and their dependents. The MMA imposes a late enrollment penalty on individuals who do not maintain creditable coverage for a period of 63 days or longer following their initial enrollment period for the Medicare prescription drug benefit. Accordingly, this information is essential to an individual's decision whether to enroll in a Medicare Part D prescription drug plan.
2. The second disclosure requirement is for entities to complete the Online Disclosure to CMS Form to report the creditable coverage status of their prescription drug plan. The Disclosure should be completed annually no later than 60 days from the beginning of a plan year (contract year, renewal year), within 30 days after termination of a prescription drug plan, or within 30 days after any change in creditable coverage status. -- This requirement does not pertain to the Medicare beneficiaries for whom entities are receiving the Retiree Drug Subsidy (RDS)."