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Home › Glossary › Creditable Coverage

Creditable Coverage

by David Bynon, September 18, 2021

What is Medicare Creditable Coverage?

Creditable coverage refers to health insurance or prescription drug benefits that meet Medicare’s minimum qualifications necessary to avoid a penalty.

Creditable coverage can be provided by individual or group health plans, as well as student health plans. There are also a number of government-sponsored and government-provided plans. Creditable coverage can be used to determine if policyholders must pay a Medicare penalty for late enrollment, or in certain cases, coverage and costs related to pre-existing conditions.

Prescription drug coverage (for example, from an employer or union) that’s expected to pay, on average, at least as much as Medicare’s standard prescription drug coverage. People who have this kind of coverage when they become eligible for Medicare can generally keep that coverage without paying a penalty if they decide to enroll in Medicare prescription drug coverage later.

 

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