What Is Creditable Coverage?
“Creditable coverage” is health insurance that is considered at least as good as Medicare’s standard coverage.
If you have creditable coverage when you become eligible for Medicare, you may delay enrolling without paying late enrollment penalties later.
If you don’t have it, you could face lifetime penalties that increase your monthly premiums.
Important Information
This interactive tool is for educational and informational purposes only. It is designed to help you understand how different types of health coverage may interact with Medicare enrollment rules.
This tool does not provide legal, financial, or insurance advice, and it does not determine eligibility for Medicare or confirm whether your coverage is considered creditable.
Results are based solely on your answers and may not reflect all Medicare rules or your specific plan details. For official guidance, visit Medicare.gov or contact 1-800-MEDICARE.
Do I Have Creditable Coverage?
Answer the questions below to understand possible Medicare enrollment risk and what you may need to verify.
1) Is your current coverage from active employment (yours or your spouse’s)?
2) Does that employer have 20 or more employees?
3) Do you currently have prescription drug coverage?
4) Have you received a “Creditable Coverage Notice” for prescriptions?
Important Information
This interactive tool is for educational and informational purposes only. It does not enroll you in Medicare, does not create an obligation to speak with an agent, and does not replace official Medicare guidance.
For official information, visit Medicare.gov or contact 1-800-MEDICARE.
How to Know if You Have Creditable Coverage
Not every plan counts. Here’s how to check:
Employer or Union Coverage
If your employer has 20 or more employees (or your spouse’s employer does), your group health plan is usually creditable.
If fewer than 20 employees, Medicare is typically primary, and your plan may not count as creditable.
Prescription Drug Coverage
Your plan must be as good as or better than Medicare Part D’s standard prescription coverage.
Each year, your insurance company will send you a “Notice of Creditable Coverage.” Keep this letter in your records.
Other Types of Coverage
VA benefits, TRICARE, and some retiree plans often count as creditable coverage, but rules can vary.
Avoid Penalties:
Part B (medical insurance) penalties add 10% for every 12 months you delay enrollment without creditable coverage.
Part D (drug plan) penalties add 1% of the national base premium for every month you go without creditable coverage.
Peace of Mind: Having proof of creditable coverage lets you transition to Medicare without worrying about higher costs.
Why Creditable Coverage Matters
What to Do Next
Look for your annual “Notice of Creditable Coverage.”
Confirm with your employer’s HR or benefits office whether your plan counts.
Save all documentation in case Medicare ever asks for proof.
Talk with a licensed agent (that’s me!) if you’re not sure how your current coverage interacts with Medicare.
