Sample Medicare Part D Notice Cover Letter

Part D Creditable Coverage

It’s the Law.  We can help.

All Employers are required to provide notice to their Employees as to whether or not their Health Plan’s Prescription Drug coverage is “Creditable” or “Non-Creditable”.

This notice needs to be given to all MEDICARE ELIGIBLE Active Employees, Spouses, Disabled Dependents and COBRA Participants by October 15th of each year.

Reporting Dates

The purpose of this notice is to provide Medicare Part D Eligible Individuals with sufficient information so that they will not unknowingly be subjected to Part D Late Enrollment Penalties. Without Proof of Creditable Coverage, those eligible for Medicare Part D, who do not enroll when they first become eligible, will owe a “Late Penalty” that is added to all future premiums.

Secondly, each Employer then needs to report to the Center for Medical Services (CMS) whether or not their plan is Creditable.

Below are some sample forms that you can use to notify your employees.

SAMPLE – Letter to Employees (Microsoft Word)

SAMPLE – Medicare D Creditable Coverage Form

SAMPLE – Medicare D Creditable Coverage Form in SPANISH

SAMPLE – Medicare D Non-Creditable Coverage Form

SAMPLE – Medicare D Non-Creditable Coverage Form in SPANISH


Click HERE to notify the CMS

Feel free to Contact Us for more information, or if you do not know whether or not your Plan is Creditable.

As you may recall Medicare Part D prescription Drug Coverage became effective in 2006.

The first enrollment period for Medicare Part D began November 15, 2005 and ended May 15, 2006.  In subsequent years individuals can enroll in a Medicare prescription drug plan when they enroll first for Medicare and now beginning in 2011 from October 15th through December 7th.  You may have heard that if you do not sign up for Medicare Part D when you are first eligible that you would have to pay more for it in the future.  This is true with one exception as explained below.

If you are currently participating in the Bates College POS or HMO Medical Plan, the prescription drug coverage provided under the plans is at least as good as what is offered under Medicare Part D.  Medicare calls this “Creditable Coverage”.  As long as you are covered under a plan that has “Creditable Coverage” then you will not be penalized for enrolling at a later date as long as you enroll in Medicare Part D within 63 days of no longer having “Creditable Coverage”.

You will need to keep a copy of the Certificate of Creditable Coverage for each year you do not choose Medicare Part D after first becoming eligible for the plan.

Below you will find a notice to plan participants, quick facts about Medicare Part D, information on the Bates Medical Plan prescription Drug Coverage through our medical carrier and Notices of Creditable Coverage.

If you have questions please contact Ken Emerson at x8271.

Notice to participants

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