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Creditable coverage letter template

Medicare creditable coverage template 2025

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The document is a Model Individual Creditable Coverage Disclosure Notice, updated for use on or after April 1, 2011. It provides essential information regarding prescription drug coverage options under Medicare, including the significance of maintaining creditable coverage to avoid penalties when joining a Medicare drug plan. The notice outlines eligibility periods for joining Medicare plans, the implications of dropping current coverage, and resources for further assistance. It emphasizes the importance of keeping this notice for future reference.

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Click ‘Get Form’ to open the medicare creditable coverage template in the editor.
Begin by inserting the name of your entity in the designated field at the top of the form. This identifies who is providing the notice.
Fill in the individual’s name and either their date of birth or unique member ID in the optional information box. This personalizes the notice for each Medicare eligible individual.
In the section detailing coverage dates, input the ranges during which the individual was covered under creditable prescription drug coverage. Ensure accuracy to avoid any penalties.
Review all filled sections for completeness and correctness before saving or exporting your document. This ensures that all necessary information is included.

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Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

What does it mean for insurance to be creditable?

Creditable coverage is insurance coverage that you can keep instead of Medicare. For your insurance coverage to qualify as creditable, it must have benefits as good if not better than what you get with Medicare.

How do I prove creditable coverage for Medicare?

A person will usually receive a Notice of Creditable Coverage in the mail every September, and they should keep this as proof should they later apply for Medicare coverage. If a person wishes to enroll in Medicare after their creditable coverage ends, they may be eligible for the Special Enrollment Period.

What is the form for creditable coverage for Medicare?

Form CMS-L564 Use this form to prove you had creditable health insurance when you sign up for Medicare Part B after age 65.

What is not considered creditable coverage?

What does Non-Creditable Coverage mean? If you are Medicare-eligible and enrolled in UC Medicare PPO without Prescription Drugs, the plan is not expected to pay out as much as standard Medicare prescription drug coverage pays. Therefore, your coverage is considered Non-Creditable Coverage.

Who sends a creditable coverage notice?

All employers that provide prescription drug coverage to Medicare Part D individuals are required to notify those individuals whether the provided coverage is creditable, as part of the Medicare Part D creditable coverage requirements.