What is a creditable prescription drug plan?

Asked by: Simone Tromp  |  Last update: August 19, 2022
Score: 4.7/5 (58 votes)

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 ...

What does creditable prescription drug coverage mean?

Most companies that provide prescription drug coverage to Medicare-eligible beneficiaries must disclose their status as creditable or non-creditable coverage. Creditable coverage means that the policy meets or exceeds the coverage offered by a Medicare Part D prescription drug plan.

How do I know if I have 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.

Is GoodRx considered creditable coverage?

GoodRx is also not considered creditable coverage. Therefore if you decide to skip enrolling in Part D in favor of GoodRx or another prescription drug discount program you will have to pay a late enrollment penalty once you decide to enroll in Medicare prescription drug coverage.

What is non-creditable prescription drug 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.

What is Creditable Prescription Drug Coverage?

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How do you prove creditable drug coverage?

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.

Is CVS Caremark creditable coverage?

Vanguard has determined that the prescription drug coverage administered by CVS Caremark is, on average for all Plan participants, expected to pay out as much as standard Medicare prescription drug coverage pays and is therefore considered creditable coverage.

Why do pharmacies hate GoodRx?

“Pharmacies hate GoodRx's system since they lose money from the potential profit, they would have made from cash paying customers and then also lose money when they pay a fee for selling to a patient who might have used their pharmacy anyway,” says Dr. Fein.

What makes a plan Medicare Part D 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.”

Is GoodRx better than Medicare Part D?

GoodRx can also help you save on over-the-counter medications and vaccines. GoodRx prices are lower than your Medicare copay. In some cases — but not all — GoodRx may offer a cheaper price than what you'd pay under Medicare. You won't reach your annual deductible.

Who provides a letter of creditable coverage?

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.

Is Aetna considered creditable coverage?

Creditable coverage, as defined under federal HIPAA, is considered as "creditable coverage" by Aetna, including: group health plan coverage (including a governmental or church plan), group or individual health insurance coverage, Medicare, Medicaid, military-sponsored health care (CHAMPUS), a program of the Indian ...

Who should receive a creditable coverage notice?

Employers must provide creditable or non-creditable coverage notice to all Medicare eligible individuals who are covered under, or who apply for, the entity's prescription drug plan (Part D eligibles), whether active employees or retirees, at least once a year.

Why is creditable coverage important?

Creditable drug coverage matters because it may allow you to delay enrolling in Medicare and avoid the Part D late enrollment penalty. The penalty is charged if you enroll in a Medicare Part D plan after your Initial Enrollment Period (IEP) ends and don't qualify for an exception.

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.

What are the 4 phases of Medicare Part D coverage?

Throughout the year, your prescription drug plan costs may change depending on the coverage stage you are in. If you have a Part D plan, you move through the CMS coverage stages in this order: deductible (if applicable), initial coverage, coverage gap, and catastrophic coverage.

Do you need Medicare Part D if you have a Medicare Advantage plan?

Nearly 90% of Medicare Advantage plans include Medicare Part D, but you can also purchase Part D separately if you have an Advantage plan that does not include it. About a third of Medicare beneficiaries had Medicare Advantage plans in 2019.

How can I avoid Medicare Part D Penalty?

3 ways to avoid the Part D late enrollment penalty
  1. Enroll in Medicare drug coverage when you're first eligible. ...
  2. Enroll in Medicare drug coverage if you lose other creditable coverage. ...
  3. Keep records showing when you had other creditable drug coverage, and tell your plan when they ask about it.

Is Express Scripts considered 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.

How credible is GoodRx?

GoodRx is rated a 4.6 out of 5 on TrustPilot with over 90% of users rating the popular discount card as excellent. Unfortunately, they also have about 10% of users that rate the service as poor or bad. The most common complaints seem to be related to customer service and changing or inaccurate discount prices.

What is a competitor to GoodRx?

WellRx. WellRx or ScriptSave WellRx as it is also known as is one of the best GoodRx alternatives that's available in the United States, as well as Guam and Puerto Rico.

Is CVS the same as CVS Caremark?

CVS Health includes the company's retail business, which continues to be called CVS/pharmacy; its pharmacy benefit management business, which is known as CVS/caremark; its walk-in medical clinics, CVS/minuteclinic; and its growing specialty pharmacy services, CVS/specialty.

Does CVS have a Part D plan?

Here are the highlights of pharmacy participation in 2022 Part D preferred networks: CVS Health. Since the 2018 plan year, CVS Health's retail pharmacies have actively pursued preferred status in Part D plans.

What is the deductible for CVS Caremark?

portion of covered expenses you must pay before coinsurance begins. Your annual deductible is $1,600 for individual coverage or $3,200 if you are covering one or more dependents.