Non-Creditable Coverage Template Letter For Employers (2018) (Page 2 of 2) in pdf

When Will You Pay A Higher Premium (Penalty) To Join A Medicare Drug Plan?

Since the coverage under {Plan Name} is not creditable, depending on how long you go without

creditable prescription drug coverage you may pay a penalty to join a Medicare drug plan. Starting

with the end of the last month that you were first eligible to join a Medicare drug plan but didn’t join, if

you go 63 continuous days or longer without prescription drug coverage that’s creditable, your

monthly premium may go up by at least 1 percent 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 percent higher than the

Medicare base beneficiary premium. You may have to pay this higher premium (penalty) as long as

you have Medicare prescription drug coverage. In addition, you may have to wait until the following

October to join.

What Happens To Your Current Coverage If You Decide to Join A Medicare Drug Plan?

If you decide to join a Medicare drug plan, your current {Employer Group} coverage may be

affected. You can keep this coverage if you elect Part D and this plan will coordinate with

Part D coverage.

If you do decide to join a Medicare drug plan and drop {Employer Group’s} medical plan, be aware

that you and your dependents may not be able to get this coverage back.

For More Information About This Notice Or Your Current Prescription Drug Coverage…

Contact our office for further information. {HR Contact Information}

NOTE: You’ll get this notice each year. You will also get it before the next period you can join a

Medicare drug plan and if this coverage changes. You also may request a copy of this notice at any

time.

For More Information About Your Options Under Medicare Prescription Drug Coverage…

More detailed information about Medicare plans that offer prescription drug coverage is in the

“Medicare & You” handbook. You’ll get a copy of the handbook in the mail every year from Medicare.

You may also be contacted directly by Medicare drug plans.

For more information about Medicare prescription drug coverage:

 Visit

 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 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048.

You can call 24 hours a day, 7 days a week.

If you have limited income and resources, extra help paying for Medicare prescription drug coverage

is available. For information about this extra help, visit Social Security on the web at

, or call them at 1-800-772-1213 (TTY 1-800-325-0778).

Non-Creditable Coverage Template Letter For Employers (2018) Page 2