Have you come across the term creditable drug coverage and wondered what it means? That is likely to remain the case for at least the next couple of years since Democrats gained control of the House of Representatives in the 2018 election. Notification to these participants is critical as that same law created a “late enrollment penalty” for those who did not have creditable coverage for 63 days or longer prior to their initial enrollment period for their Medicare prescription drug benefit. The bottom line: If you had at least 18 months of health coverage at your previous job and you enrolled in your new employer-sponsored health plan without a break of 63 days or more, your new health plan could not subject you to a pre-existing condition exclusion. This consumer protection was already in place before the ACA, and efforts to repeal and replace the ACA (in 2017 but also potential future efforts) would not impact this provision, as it's part of HIPAA rather than the ACA. Employers are also responsible for notifying each plan option’s credibility status (note: many plans have more than one health plan option) to all active employees, plan participants, and any covered retirees that may be Medicare eligible. healthinsurance.org. Norris L. 12 ways the GOP sabotaged Obamacare. Although temporary pre-existing condition exclusion periods were used, it was also common to see permanent pre-existing condition exclusions in the individual health insurance market. Department of Labor. How Much Does COBRA Health Insurance Cost? Here are Some Resources You Can Use, VIDEO: In the Hot Seat with Annie Carroll, Co-Owner. Richard N. Fogoros, MD, is a retired professor of medicine and board-certified in internal medicine, clinical cardiology, and clinical electrophysiology. Non-Group Coverage Rules for HIPAA Eligible Individuals. Our Culture We can help →. Careers, FIND HEALTH INSURANCE Access to coverage and care for people with preexisting conditions: How has it changed under the ACA? Commonwealth Fund. Kathryn Anne Stewart is a freelance writer who covers the intersection of health and money. You are only required to a) notify the government annually and b) notify all active employee plan participants and covered retirees that could be Medicare eligible. Many employers tend to include the creditable status in their open enrollment packets or to new hires as they come on board. Assuming you have Medicare eligibility, your health insurance plan will send you a letter every year, usually around September.1 Keep this letter, also known as a notice of creditable coverage or certificate of creditable coverage. Generally, a significant break in coverage is a period of 63 consecutive days during which you have no creditable coverage. 2017;107(4):538-540. doi:10.2105/AJPH.2017.303665. One of the hallmarks of the Patient Protection and Affordable Care Act signed into law in March 2010, was the elimination of pre-existing condition requirements imposed by health plans. Individual market plans: For example, Lori was a 48-year-old freelance writer, obtaining health coverage in the pre-ACA individual market. These protections include:. Accordingly, this information is essential to an individual's decision whether to enroll in a Medicare Part D prescription drug plan. How Do State-Based Individual Mandates Work? The bottom line. Usually guarantees that if you purchase health insurance, you can renew your coverage regardless of any health conditions in your family. Keep in mind, Medicare does not always apply to those 65 years or older. If you are on a non-Medicare plan that includes prescription drug coverage but you are also eligible for Medicare, it’s important to know if your current health plan provides creditable drug coverage. If you can prove (via the creditable coverage letter) that you had drug coverage with no gap of 63 days or more, you won’t have to pay the Part D late enrollment penalty. Sign up for our Health Tip of the Day newsletter, and receive daily tips that will help you live your healthiest life.
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