CALIFORNIA MEDICARE GUIDE
Part D Creditable Coverage: What to Do With Your Letter
Understand what a creditable prescription-drug-coverage notice means and which questions to verify before making a change.
Keep the notice and read what it says
Creditable prescription drug coverage is coverage expected, on average, to pay at least as much as Medicare drug coverage. Medicare says a current plan must tell you whether its prescription coverage is creditable. Keep that written notice with your insurance records.
If you go 63 days or more in a row without Medicare drug coverage or other creditable drug coverage after you are eligible, you may have to pay a Part D late-enrollment penalty if you enroll later. Whether that applies depends on your actual coverage history and Medicare’s rules.
Do not add or drop coverage without checking first
Employer, union, retiree, VA, TRICARE, and other coverage can have their own rules. Medicare warns that joining Medicare drug coverage can affect employer or union coverage for you, your spouse, or dependents. Ask the benefits administrator, insurer, or plan in writing before changing coverage.
A discount card, free clinic, or drug discount website is not prescription-drug insurance. Bring the notice and your questions to any review.
Use an informed conversation
A licensed insurance agent can discuss the products the agency represents and the questions to verify. The coverage provider determines and discloses whether its prescription drug coverage is creditable. Medicare and the plan handle any later enrollment-penalty process.
Keep copies of notices and the name of the coverage source that issued them. If a future plan asks about prior drug coverage, answer from your records and follow the deadline on its request. If you cannot find an older notice, contact the former coverage source right away. If the plan asks for proof and your records are unavailable, contact that plan and address its request by the deadline it gives you.
Three things to do next
- Keep the creditable-coverage notice with your insurance records.
- Ask the coverage source in writing before adding or dropping drug coverage.
- Bring the notice to any coverage conversation and keep copies of future notices.
Check the official sources
- Medicare: creditable prescription drug coverage (opens in a new tab)
- CMS: creditable coverage and late-enrollment penalty (opens in a new tab)
- Medicare: avoid late enrollment penalties (opens in a new tab)
We prepare these explanations from the listed sources. This is general education, not a personalized recommendation. Confirm current rules and individual dates with the appropriate official source. Our editorial approach.