Prescription Creditable Coverage

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.

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.

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.

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. 

Western Health Advantage, Member Services Department
2349 Gateway Oaks Drive, Suite 100, Sacramento, CA 95833
Call: 916-563-2250 • 1-888-563-2250 toll-free • 711 TTY

IMPORTANTE: ¿Puede leer esta carta? Si no, nosotros le podemos ayudar a leerla. Además, usted puede recibir esta carta escrita en español. Para obtener ayuda gratuita, llame ahora mismo a Western Health Advantage al 1-888-563-2250, de lunes a viernes de 8 a.m. a 6 p.m.

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).