Defining Creditable Coverage Part D

[somarco]

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.

 

[TwoCents]

From the Medicare Advantage and PDP perspective: It doesn't matter unless CMS makes an update regarding the creditable coverage attestation process that absolutely requires Part D plans to ensure the information being provided by the client is true and correct.

As it is now, a form is sent out by the plans when there is a potential gap in coverage that could trigger the Part D late enrollment penalty. Pa Kettle is probably not paying attention to whether his former employer coverage is creditable or not. He's just going to fill out that form saying he had employer coverage beginning on one date and ending on another. If the gap is accounted for by the provided information, then there should be no LEP assessed.

 

[LostDollar]

From the Medicare Advantage and PDP perspective: It doesn't matter unless CMS makes an update regarding the creditable coverage attestation process that absolutely requires Part D plans to ensure the information being provided by the client is true and correct.

As it is now, a form is sent out by the plans when there is a potential gap in coverage that could trigger the Part D late enrollment penalty. Pa Kettle is probably not paying attention to whether his former employer coverage is creditable or not. He's just going to fill out that form saying he had employer coverage beginning on one date and ending on another. If the gap is accounted for by the provided information, then there should be no LEP assessed.

According to a CMS manual section which I think you referred to me a few years ago, and which I ran onto again recently, Pa Kettle is not even required to pay attention to whether or not the coverage is creditable, for an initial attestation.

However, over Pa's signature, the form does say Pa understands he must provide creditability info if asked to do so, so I think the Part D carriers have the authority to ask now. So, in theory, I think Part D plans are allowed to ask for creditability info now, and could assess LEP's if the creditability info is not provided. I don't know whether they would actually ever do that.

 

[goillini52]

According to a CMS manual section which I think you referred to me a few years ago, and which I ran onto again recently, Pa Kettle is not even required to pay attention to whether or not the coverage is creditable, for an initial attestation.

However, over Pa's signature, the form does say Pa understands he must provide creditability info if asked to do so, so I think the Part D carriers have the authority to ask now. So, in theory, I think Part D plans are allowed to ask for creditability info now, and could assess LEP's if the creditability info is not provided. I don't know whether they would actually ever do that.

 

[LostDollar]

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.

 

[MedicareWAA]

Credible D is based on a simple self attestation. No one asks for additional proof, no one investigates. You attest under penalty of perjury and the government assumes you’re telling the truth. Your group plan is not involved. Theres no reason to think this will change.

Walter

 

[LostDollar]

Credible D is based on a simple self attestation. No one asks for additional proof, no one investigates. You attest under penalty of perjury and the government assumes you’re telling the truth. Your group plan is not involved. Theres no reason to think this will change.

Walter

Caveat, not an agent.

That is not strictly correct, in terms of the legalities.

Over their signature on the attestation form, the applicant also states they understand they may have a higher premium if they don't give proof of creditable coverage if asked.

Just because the current carrier daily practices do not usually involve asking for that proof does not mean the carrier practices may not change in the future, which they could do under the current legal rules. the one constant about Medicare is that is complicated and ever changing, both in guidelines and practice.

Edit:
And the group plan IS involved. You have to provide the group plan carrier names and dates of coverage to complete the attestation.

That, at least, is the procedure for the sample attestation form provided by Medicare, and the specific attestation form required from me by SilverScript.

End edit.

 

[MedicareWAA]

Caveat - I am an agent.

I’m just telling you how it’s been done for the last 20 some years. You make a self attestation and the government assumes you’re being truthful. No one asks you for proof. No one calls your group plan administrator. Completely different than how Part B is handled.

The Part D plans collect the attestations and they have absolutely no incentive to challenge the member.

Also, disclosing the name of the group doesn’t mean the group is involved.

Could it change? Maybe. Anything can change. Judging by history, and by current public policy debates, nothing will change. Government can’t even crack down on blatantly fraudulent special election enrollment codes. No one is gonna send the A Team to investigate your attestation.

Legally, you shouldn’t lie on your attestation. Practically, no one checks. Just be a good person and tell the truth.

Walter

 

[LostDollar]

Caveat - I am an agent.

I’m just telling you how it’s been done for the last 20 some years. You make a self attestation and the government assumes you’re being truthful. No one asks you for proof. No one calls your group plan administrator. Completely different than how Part B is handled.

The Part D plans collect the attestations and they have absolutely no incentive to challenge the member.

Also, disclosing the name of the group doesn’t mean the group is involved.

Could it change? Maybe. Anything can change. Judging by history, and by current public policy debates, nothing will change. Government can’t even crack down on blatantly fraudulent special election enrollment codes. No one is gonna send the A Team to investigate your attestation.

Legally, you shouldn’t lie on your attestation. Practically, no one checks. Just be a good person and tell the truth.

Walter

Caveat, I AM a Medicare Beneficiary who has obtained Part D by attestation with SilverScript.

SilverScript SPECIFICALLY REQUIRED that I provide them with all the specific carrier names and from - to dates of coverage. That WAS the (multiple) EGH plans I had between my Part A effective date and my SilverScript part D effective date.

SilverScript did not ask me to provide the employer letters about creditability of coverage, but they did ask for the specific carrier names.

This is PRECISELY in line with the minimum attestation requirements presented in a guideline Part D attestation form presented in CMS documentation.

Maybe you have never sold a SilverScript Part D plan or maybe you have bent the rules for your clients. I don't know. What I can tell you is my specific experience and the CMS Medicare manual on that issue.

 

[MedicareWAA]

Yep, I’ve seen maybe 1,000 of these throughout my career. So have all the other agents in this group. We know exactly what it says, and we know exactly how the process works.

I tell people to answer the questions honestly and in good faith but not to overthink it. Otherwise people spend a week figuring out of their group plan started in February of 1988 or was it April of 1989.