As soon as you turn 65, you are likely inundated with mail and people reaching out to get you to sign up for Medicare. But you may not need to sign up if you are still working and have creditable coverage. How can you tell if you have creditable coverage? Read on to find out.
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. Typically, your private insurance coverage is creditable if you work for a company with at least 20 employees. But there are exceptions, so we recommend you check with your company's human resources department to verify that you have creditable coverage.
Employer/Union and other group health plans are required to provide Medicare-eligible employees with a Notice of Creditable Coverage each year by October 15th.
Suppose you do not have creditable coverage and you choose not to enroll in Medicare. In that case, you will likely face a lifetime Late Enrollment Penalty (LEP) in addition to your monthly premium. For Part B Part D
For example, if you turned 65 this year and did not enroll in Medicare for a year despite not having creditable coverage, your monthly premiums would be $203.50 for Part B ($185 + $18.50) and $41.98 ($36.78 + $5.20) for Part D.
In the example above, $36.78 is an average premium, but the penalty will be in addition to whatever your monthly premium is for your specific plan.
The decision on whether to keep your insurance is something we've covered before when considering employer's insurance your spouse's Fair Square Medicare
Some people decide to double up on coverage. For example, people like to add Medicare as a secondary payer
The standards for Part D are as follows. To be considered creditable, your private health insurance plan must:
Pay at least 60% of prescription drug costs
Cover name brand and generic drugs
Include a variety of pharmacies to choose from
Not have a low deductible or an annual benefit cap amount
As mentioned earlier, you should receive a Notice of Creditable Coverage.
The Notice of Creditable Coverage
COBRA is an individual policy created to mimic your former employer's group health plan. COBRA is not creditable coverage. So you will need to sign up for Medicare. Referencing the primary vs. secondary distinction from earlier, COBRA pays secondary to Medicare because it does not offer suitable coverage. In addition to COBRA following insurance options are not replaceable for creditable coverage:
CHAMPVA, Veterans Benefits, and TRICARE might be creditable coverage for your Part D prescription drug plan (however, for Veterans Benefits if a non-VA doctor prescribes a prescription they will not fill/cover it).
GoodRx
You can keep your employer's health insurance policy as long as it's creditable coverage. If you don't have creditable coverage, you should sign up for Medicare as soon as possible. You could face penalties for not switching to Medicare, depending on your situation. If you have a unique case not listed above, call us today at 1-888-376-2028. Our team of experts is trained to help work through all kinds of problems.
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Virgil Insurance Agency, LLC (DBA Fair Square Medicare) and www.fairsquaremedicare.com are privately owned and operated by Help Button Inc. Medicare supplement insurance plans are not connected with or endorsed by the U.S. government or the federal Medicare program. This is a solicitation of insurance. A licensed agent/producer may contact you. Medicare Supplement insurance is available to those age 65 and older enrolled in Medicare Parts A and B and, in some states, to those under age 65 eligible for Medicare due to disability or End-Stage Renal disease. Virgil Insurance Agency is a licensed and certified representative of Medicare Advantage HMO, HMO SNP, PPO, PPO SNP and PFFS organizations and stand-alone PDP prescription drug plans. Each of the organizations we represent has a Medicare contract. Enrollment in any plan depends on contract renewal. The plans we represent do not discriminate on the basis of race, color, national origin, age, disability, or sex. Plan availability varies by region and state. For a complete list of available plans please contact 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day/7 days a week or consult www.medicare.gov. © 2025 Help Button Inc
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