Defining Creditable Coverage Part D

[TwoCents]

CMS could make the creditability information more readily accessible to MBs by adding it to CMS' mandatory EGH plan information reporting requirements, and then in turn, add the creditability data to the EGH plan information they display for Medicare Beneficiaries in the MB's MyMedicare account.

CMS is not going to do this. CMS and the VA don't communicate about veterans with creditable drug coverage so why would CMS start with group plans? Setting up with essentially one entity (VA) would be far simpler than trying to coordinate with all the employers out there.

 

[LostDollar]

CMS is not going to do this. CMS and the VA don't communicate about veterans with creditable drug coverage so why would CMS start with group plans? Setting up with essentially one entity (VA) would be far simpler than trying to coordinate with all the employers out there.

CMS already has mandatory group plan information reporting requirements in place.

A small piece of that info is already recorded in MyMedicare accounts.

Since the mandatory reporting is due to COB issues, it may also include VA reporting, I don't know because I don't see VA specifically listed in required reporting entities. (and my post was not about VA, it was about EGH plans)

 

[LostDollar]

CMS is not going to do this. CMS and the VA don't communicate about veterans with creditable drug coverage so why would CMS start with group plans? Setting up with essentially one entity (VA) would be far simpler than trying to coordinate with all the employers out there.

CMS already has mandatory group plan information reporting requirements in place.

A small piece of that info is already recorded in MyMedicare accounts.

Since the mandatory reporting is due to COB issues, it may also include VA reporting, I don't know because I don't see VA specifically listed in required reporting entities. (and my post was not about VA, it was about EGH plans)

(Caveat, not an agent)

In the other thread, you told me no one was listening and expressed concern about my mental stability, so I will limit my comment here to the following:

I now think the current information flow to CMS is likely to include VA data.

One of the links I cited in the other thread includes this:

COB Agreement (COBA) Program - CMS consolidates the Medicare paid claim crossover process through the COBA program. The COBA program established a national standard contract between the BCRC and other health insurance organizations for transmitting enrollee eligibility data and Medicare paid claims data. This means that Medigap plans, Part D plans, employer supplemental plans, self-insured plans, the Department of Defense, title XIX state Medicaid agencies, and others rely on a national repository of information with unique identifiers to receive Medicare paid claims data for the purpose of calculating their secondary payment. The COBA data exchange processes have been revised to include prescription drug coverage.

My uninformed, non-agent, opinion would be that Department of Defense above (not bolded in source document) probably includes VA. you will have to expand the quoted block to see the reference.

 

[MedicareWAA]

(Caveat, not an agent)

In the other thread, you told me no one was listening and expressed concern about my mental stability, so I will limit my comment here to the following:

I now think the current information flow to CMS is likely to include VA data.

One of the links I cited in the other thread includes this:



My uninformed, non-agent, opinion would be that Department of Defense above (not bolded in source document) probably includes VA. you will have to expand the quoted block to see the reference.

Bro, we get it. You're not an agent. You don't need to give this warning every time you say something here.

Still not sure why you're so active in a group for insurance agents and brokers, though …

Walter

 

[Yagents]

Bro, we get it. You're not an agent. You don't need to give this warning every time you say something here.

Still not sure why you're so active in a group for insurance agents and brokers, though …

Walter

I think the forum moderators required him to state he's not an agent to remain active and not mislead the general public

 

[LostDollar]

Bro, we get it. You're not an agent. You don't need to give this warning every time you say something here.

Still not sure why you're so active in a group for insurance agents and brokers, though …

Walter

Thank you, but I really do.

I started that several years ago when I was a new forum member. My presence was not well tolerated. One of the criticisms was that my posts appeared to be from an agent, but were not.

Several people made comments about how restriction should be indicated in my posts. I adopted what I say now.

I have learned from a few events over the years that readership of some information here will go far beyond a very limited circle of agents who post regularly. So many readers of some of my posts will not know I am not an agent.

I sometimes respond to posts by agents who do not post regularly. It is extremely important (to me at least) that those people know my comments do not come from an experience base of talking to 1,000's of people, nor do they come from an individual who shares the same e&o liability obligations they have.

In addition, just the sheer number of post I now have could cause someone to believe they are hearing from an agent when they are not.

It's kind of like some of you stating you are not attorneys, cpa's or tax professionals when you provide some comments or advice and also state the comment or advice does not constitute legal or tax advice.

I apologize for the annoyance you feel, but overall it is more important that I say it than I don't. (and I also know from experience that the information I have in my footnote is not adequate disclosure of my status for post readers.)

 

[LostDollar]

Still not sure why you're so active in a group for insurance agents and brokers, though …

Walter

Medicare agents are too staid and overwhelmed with misery due to DSNP MA plans.

They need a groupie!



(At least one Medicare agent has commented that he, or she, is happy to have one.)

Regards
LD

 

[kgmom219]

This is an excellent article on the topic of creditable coverage. Carefully researched and sheparized by the staff at Ritter. My biggest complaint is the web designer. The page is pretty but very difficult to read with a very light font against a white background.


"Group health plans are not required to offer coverage that's creditable. However, if they provide prescription drug coverage to individuals who are eligible for Medicare Part D, they must inform them and CMS whether or not their coverage is creditable on an annual basis. In cases where the coverage is not creditable, the late enrollment penalty will be added to the beneficiary's monthly Part D premium. Its cost depends on how long the individual went without Part D or creditable coverage upon becoming Medicare eligible. This penalty will generally be imposed for as long as you have Medicare coverage." — Kendra Fulmer, Carrier Team Manager

The Medicare Part D Creditable Coverage Determination Changes for 2025 or Beyond

What is Medicare Part D creditable coverage and how is it changing? We cover the creditable drug coverage determination changes and if your clients are at increased risk for late enrollment penalties.

ritterim.com

I wonder what @kgmom219 thinks.

That's an accurate statement and it's a DOL requirement, due by 10/15 annually.

 

[kgmom219]

Ok, here's how this is going to work in real life.

1. If you've got these people (past their IEP but get checked in on), get in front of them before Labor Day. If they are not contributing to an HSA, recommend enrollment in Part A ONLY.

2. If you work with Financial Planners (or want to), same answer. My FPs are creating lists now for an 8/2 email, zoom calls are scheduled by planner.

3. By 10/16, they should know if their coverage is creditable or not. General rule is that fully insured groups "should" be creditable (including $9450 deductible plans with no copays) and self funded plans are a crapshoot.

4. If they already have a Part A number, your life is so much easier. Whether they go all in with B or just Part D.

5. Dec 7 DOES NOT APPLY. They have until 12/31 for 1/1 and until 3/2 to enroll. (It's 60 days and this isn't a leap year.)

6. Everything comes into the mix. IRMAA. Cost of Employer coverage. Cost of Part D. LEP for 2025.

Thank you and please don't forget the hat when it's passed

 

[rmhaire]

I started that several years ago when I was a new forum member. My presence was not well tolerated. One of the criticisms was that my posts appeared to be from an agent, but were not.

Nowhere in the owner's manual does it say you have to have an insurance license to be a member and post on this forum.

I personally enjoy reading your posts. And that's more than I can say about a few wack jobs that post on here.