Medicare Creditable Coverage

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Medicare prescription drug coverage provides medication and prescription benefits to eligible employees.

Understanding how this coverage interacts with Adelphi University’s prescription drug benefits is crucial for making informed healthcare decisions. Below, you’ll find frequently asked questions and important notices to help you navigate your options under Medicare’s prescription drug coverage.

Important Notice from Adelphi University About Your Prescription Drug Coverage and Medicare

Please read this notice carefully and keep it where you can find it.

This notice has information about your current prescription drug coverage with Adelphi University and about your options under Medicare’s prescription drug coverage. This information can help you decide whether or not you want to join a Medicare drug plan. If you are considering joining, you should compare your current coverage, including which drugs are covered at what cost, with the coverage and costs of the plans offering Medicare prescription drug coverage in your area. Information about where you can get help to make decisions about your prescription drug coverage is at the end of this notice.

There are two important things you need to know about your current coverage and Medicare’s prescription drug coverage:

  1. Medicare prescription drug coverage became available in 2006 to everyone with Medicare. You can get this coverage if you join a Medicare Prescription Drug Plan or join a Medicare Advantage Plan (like an HMO or PPO) that offers prescription drug coverage. All Medicare prescription drug plans provide at least a standard level of coverage set by Medicare. Some plans may also offer more coverage for a higher monthly premium.
  2. Adelphi University has determined that the prescription drug coverage offered by your plan 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. Because your existing coverage is Creditable Coverage, you can keep this coverage and not pay a higher premium (a penalty) if you later decide to join a Medicare drug plan.

Medicare Creditable Coverage FAQs

You can join a Medicare drug plan when you first become eligible for Medicare and each year from October 15 through December 7. However, if you lose your current creditable prescription drug coverage, through no fault of your own, you will also be eligible for a two (2) month Special Enrollment Period (SEP) to join a Medicare drug plan.

If you decide to join a Medicare drug plan, you can keep your current Adelphi University coverage and this plan will coordinate with Part D coverage; for those individuals who elect Part D coverage, See pages 7- 9 of the CMS Disclosure of Creditable Coverage To Medicare Part D Eligible Individuals Guidance which outlines the prescription drug plan provisions/options that Medicare eligible individuals may have available to them when they become eligible for Medicare Part D.

If you do decide to join a Medicare drug plan and drop your current Adelphi University coverage, be aware that you and your dependents will not be able to get this coverage back.

You should also know that if you drop or lose your current coverage with Adelphi University and don’t join a Medicare drug plan within 63 continuous days after your current coverage ends, you may pay a higher premium (a penalty) to join a Medicare drug plan later. If you go 63 continuous days or longer without creditable prescription drug coverage, your monthly premium may go up by at least 1% of the Medicare base beneficiary premium per month for every month that you did not have that coverage.

For example, if you go nineteen months without creditable coverage, your premium may consistently be at least 19% higher than the Medicare base beneficiary premium. You may have to pay this higher premium (a penalty) as long as you have Medicare prescription drug coverage. In addition, you may have to wait until the following October to join.

Need More Information?

About This Notice and Your Current Prescription Drug Coverage

For further details about this notice or your current prescription drug coverage, please contact the person(s) listed below. You will receive this notice each year and before each Medicare drug plan enrollment period. Additionally, you can request a copy of this notice at any time.

Medicare Prescription Drug Coverage Options

For detailed information about Medicare prescription drug coverage options, refer to the “Medicare & You” handbook. This handbook, which is mailed to you each year by Medicare, contains comprehensive details about available plans. Additionally, you may receive direct contact from Medicare drug plans.

Understanding Medicare Prescription Drug Coverage

For more information about Medicare prescription drug coverage, please:

  • Visit medicare.gov
  • Call your State Health Insurance Assistance Program (see the inside back cover of your copy of the “Medicare & You” handbook for their telephone number) for personalized help
  • Call 800.MEDICARE (800.633.4227) / TTY 877.486.2048

If you have limited income and resources, extra help paying for Medicare prescription drug coverage is available. For information about this extra help, visit the Social Security website, or call them at 800.772.1213 / TTY 800.325.0778.

Remember to keep this Creditable Coverage notice. If you decide to join a Medicare drug plan, you may need to provide a copy of this notice to confirm whether you have maintained creditable coverage and whether you are required to pay a higher premium (penalty).

Additional Resources

Centers for Medicare & Medicaid Services
Creditable Coverage
Disclosure to CMS Guidance and Instructions
Medicare Information
Medicare & You Handbook
Medicare Website

Benefits Specialists

Human Resources

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E-mail
humanresources@adelphi.edu
Phone Number
516.877.3220
Fax
516.877.4970
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