Federal law requires us to tell you that your HMSA drug plan is a creditable drug plan. This is especially important if you’re eligible for Medicare since creditable drug coverage affects your drug options and costs. Here are answers to common questions about creditable drug coverage, its importance, why you received a letter from HMSA, and what it means for you.

Frequently Asked Questions

What’s creditable drug coverage?

• Creditable drug coverage is prescription drug coverage that meets Medicare’s minimum standards of paying, on average, at least as much as Medicare’s standard prescription drug coverage.

Why is creditable drug coverage important?

• If you have Medicare or are eligible for Medicare, please keep the creditable drug coverage notice for your records. If you decide to join a Medicare drug plan, you may be required to provide a copy of this notice to show that you have creditable coverage. This could help you avoid paying a penalty.

Who determines if my drug coverage is creditable?

• HMSA evaluates the prescription drug coverage each year, comparing it to standard Medicare Part D and using guidelines from the Centers for Medicare & Medicaid Services to determine creditable coverage.

How will I know if my coverage is creditable?

• We’ll notify you annually to let you know if your prescription drug coverage is creditable. We’ll send you a written notice before Oct. 15, the beginning of the Medicare Part D annual enrollment period. Save this notice just in case you need it to enroll in Medicare later.

How will I receive the creditable coverage notice?

• We’ll mail you the notice each year. Please watch for the notice in the mail and keep it for your records.

Do I need to keep the cover letter and the notice?

• Yes. Both the cover letter and the notice are required to verify creditable coverage for Medicare. Please keep both for your records.

Why didn’t my spouse also get a letter and notice?

• We only send letters and notices to subscribers. If your spouse is covered under your plan, please keep your cover letter and notice along with your HMSA membership card for Medicare enrollment purposes.

What should I do if I am eligible for Medicare?

• If you have Medicare or will become eligible for Medicare, you should review your Medicare Part D options and enroll when appropriate if you do not have another source of creditable prescription drug coverage.
• Enrolling in Medicare Part D on time can help you avoid a possible Medicare Part D late enrollment penalty.

When can I enroll in Medicare Part D?

• Your enrollment opportunity depends on your individual circumstances. Medicare has several enrollment periods, including:
  • Your Initial Enrollment Period when you first become eligible for Medicare.
  • Medicare Open Enrollment, generally October 15 through December 7.
  • Certain Special Enrollment Periods that may apply when creditable prescription drug coverage is lost or changes to non-creditable coverage.
  • Because enrollment rules vary, Medicare-eligible members should review their options promptly.

Where can I get help with Medicare Part D?

• Visit Medicare.gov or call 1-800-MEDICARE (1-800-633-4227) to learn about Medicare Part D plans, enrollment periods, and whether a late enrollment penalty could apply to you.

NEW for Plan Year 2027 - Bronze Prescription Coverage considered Non-Creditable

Why is my HMSA Bronze prescription drug coverage considered non-creditable for Medicare Part D in 2027?

• Medicare changed the standard it uses to determine whether prescription drug coverage is considered creditable. 60% of participants’ prescription drug expenses, on average, to meet that part of the creditable coverage test.
• For 2027, Medicare increased this threshold to 73%. Because of this higher Medicare standard, HMSA Bronze PPO I and Bronze PPO II HSA prescription drug coverage no longer meet Medicare’s definition of creditable coverage for 2027.

Did HMSA reduce my Bronze prescription drug benefits?

• No. HMSA did not reduce the Bronze prescription drug benefits in a way that caused the coverage to become non-creditable.
• The change is primarily the result of Medicare strengthening its standard for determining whether other prescription drug coverage is comparable to Medicare Part D.

Does non-creditable mean my HMSA Bronze plan no longer covers prescription drugs?

• No. Your HMSA Bronze plan still includes prescription drug coverage.
• “Non-creditable” only means that the prescription drug coverage does not meet Medicare’s 2027 standard for coverage comparable to Medicare Part D. It does not mean that you have no prescription drug coverage.