Creditable Coverage

Medicare prescription drug coverage became available in 2006 to everyone with Medicare. You can get this coverage if you join a Medicare Prescription Drug Plan or join a Medicare Advantage Plan (like an HMO or PPO) that offers prescription drug coverage. All Medicare drug plans provide at least a standard level of coverage set by Medicare. Some plans may also offer more coverage for a higher monthly premium.

Each year, WHA determines which of its offered prescription drug plans are "creditable." This term is applied to a plan if it is, on average for all plan participants, expected to pay out as much as standard Medicare prescription drug coverage pays. If your WHA plan is creditable, then you can keep this coverage and not pay a higher premium (a penalty) if you later decide to join a Medicare drug plan.

For More Information About Your Current Prescription Drug Coverage

Proof of creditable status is available by signing up and logging in to mywha.org; once in your MyWHA account, look under MyDocuments/My Benefits. In the event that your plan is not considered creditable, there will be a specific non-creditable notification available to provide information specific to you and your current coverage. 

If you are Medicare-eligible, WHA will mail you your notification before the next period that you can join a Medicare drug plan. You may request a copy of this notice at any time by contacting WHA's Member Services Department. Call 916-563-2250, 1-888-563-2250 toll-free, or 711 for TTY.

Determine Whether a WHA Plan is Creditable

Look below to find your current or a prospective plan, if shopping for new coverage or looking to switch plans. Plans are organized by Individual, Small Group, and Large Group.

INDIVIDUAL & FAMILY PLANS

SMALL GROUP PLANS

LARGE GROUP PLANS

Creditable Coverage Notification

This information can help you decide whether or not you want to join a Medicare drug plan. If you are considering joining, you should compare your current coverage, including which drugs are covered at what cost, with the coverage and costs of the plans offering Medicare prescription drug coverage in your area. Information about where you can get help to make decisions about your prescription drug coverage is at the end of this notice. 

When Can You Join a Medicare Drug Plan?

You can join a Medicare drug plan when you first become eligible for Medicare and each year from October 15th to December 7th. However, if you lose your current creditable prescription drug coverage, through no fault of your own, you will also be eligible for a two (2) month Special Enrollment Period (SEP) to join a Medicare drug plan.

What Happens to Your Current Coverage if You Decide to Join a Medicare Drug Plan?

If you decide to join a Medicare drug plan, your current Western Health Advantage coverage will not be affected. You can keep this coverage if you elect Medicare Part D coverage, and we will coordinate your prescription drug benefits with Medicare. If you decide to join a Medicare drug plan and drop your current Western Health Advantage coverage, be aware that you and your dependents will not be able to get this coverage back until the next open enrollment period, unless you experience a qualifying event. 

When Will You Pay a Higher Premium (Penalty) To Join a Medicare Drug Plan?

You should also know that if you drop or lose your current coverage with Western Health Advantage and don't join a Medicare drug plan within 63 continuous days after your current coverage ends, you may pay a higher premium (a penalty) to join a Medicare drug plan later. If you go 63 continuous days or longer without creditable prescription drug coverage, your monthly premium may go up by at least 1% of the Medicare base beneficiary premium per month for every month that you did not have that coverage. For example, if you go nineteen months without creditable coverage, your premium may consistently be at least 19% higher than the Medicare base beneficiary premium. You may have to pay this higher premium (a penalty) as long as you have Medicare prescription drug coverage. In addition, you may have to wait until the following October to join.

For More Information About This Notice or Your Current Prescription Drug Coverage

Proof of creditable status is available by signing up and logging in to mywha.org; once in your MyWHA account, look under MyDocuments/My Benefits. In the event that your plan is not considered creditable, there will be a specific non-creditable notification available to provide information specific to you and your current coverage. 

If you are Medicare-eligible, WHA will mail you your notification before the next period that you can join a Medicare drug plan. You may request a copy of this notice at any time by contacting WHA.

For More Information About Your Options Under Medicare Prescription Drug Coverage

More detailed information about Medicare plans that offer prescription drug coverage is in the "Medicare & You" handbook. You'll get a copy of the handbook in the mail every year from Medicare. You may also be contacted directly by Medicare drug plans. For more information about Medicare prescription drug coverage:

1. Visit www.medicare.gov
2. Call your State Health Insurance Assistance Program (see the inside back cover of your copy of the "Medicare & You" handbook for their telephone number) for personalized help
3. Call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048.

If you have limited income and resources, extra help paying for Medicare prescription drug coverage is available. For information about this extra help, visit Social Security on the web at www.socialsecurity.gov, or call them at 1-800-772-1213 (TTY 1-800-325-0778).