What happens if I am unable to provide creditable coverage?

Question

Lt Col Tim Brown · Accepted Answer

Usually you just answer the letter or form they send to you asking you about it.  You check off the box that says you had it.  If they pursue that further, there is a form the employer has and fills out stating you had it.  If you had an individual plan, you can use that to provide proof.  If you have nothing to back it up (should they ask for that) you will be paying a penalty forever.  

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Steve Houchens · Answer

If you are unable to prove credible coverage you may incur additional costs penalty of either Medicare  part B or part D if you didn’t enroll when you were first eligible.

Leslie Kaz · Answer

If you go without creditable coverage for too long, you could face a late enrollment penalty when you sign up for Medicare Part B or Part D.

Part B (Medical Insurance) – If you don’t have creditable coverage and delay enrolling, your premium may go up 10% for every 12 months you were eligible but didn’t sign up. This penalty is permanent.

Part D (Prescription Drug Coverage) – If you go 63 days or more without creditable drug coverage, you may pay an extra monthly penalty for as long as you have Part D.

Creditable coverage means your existing insurance is at least as good as Medicare’s standard coverage. If you’re ever unsure whether your plan is creditable, ask your insurer for a written notice—keep it in your records in case Medicare ever asks for proof.

Tracy Davis · Answer

If you are unable to provide credible coverage after 63 days then you will begin to accrue a late enrollment penalty. This penalty will be attached to your part d plan for the remainder of your lifetime unless you receive Medicaid or LIS for lower earners.

Answered by Tracy Davis on August 11, 2025

Broker Licensed in IN, CO, FL & KY, NM, OH & TN

Answered by Tracy Davis Medicare Insurance Agent

Patricia Graham · Answer

I this case, there would be fines associated with coverage that is not credible after the age of 65.

Ronnie Robinson · Answer

You may be subject to penalties without proof that you had creditable coverage prior to being eligible for Medicare, especially if outside of your initial enrollment period around your 65th birthday. Those penalties could last for the rest of your life.

Answered by Ronnie Robinson on August 12, 2025

Broker Licensed in FL, AL, IL & 8 other states

Answered by Ronnie Robinson Medicare Insurance Agent

Jerry Naylor · Answer

If you lose creditable coverage there is normally a special enrollment period to enroll in Part D without penalty. 

If you don’t have creditable coverage and delay enrollment in Part D you may face a late enrollment penalty.

Mark Holmes · Answer

Without a Special Enrollment Period, you will need to wait for Open Enrollment for the type of plan you would like to apply for.

Julie Hamilton, RN · Answer

If you are unable to provide proof of creditable coverage, you will likely face late enrollment penalties for both Part B and Part D. The Part B premium penalty is 10% for each full 12 month period you were eligible for Part B but didn't enroll and didn't have creditable coverage. For Part D, you may pay a penalty of an extra 1% of the national base premium for each full month you were eligible but didn't join a plan and didn't have creditable drug coverage. This amount is added to your monthly Part D premium for as long as you have the coverage and changes annually.

Answered by Julie Hamilton, RN on August 12, 2025

Broker Licensed in GA, AL, SC & TN

Answered by Julie Hamilton, RN Medicare Insurance Agent

What happens if I am unable to provide creditable coverage?

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What happens if I am unable to provide creditable coverage?

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