Exemptions to the Individual Mandate
There are some cases where there is no penalty to not having coverage.
This is health coverage based on your, your spouse’s, or other family member’s current or former employment. If you have prescription drug coverage based on employment, the employer or union will notify you each year to let you know if your drug coverage is creditable*.Keep the Information You Get
This is a federal law that may allow you to temporarily keep employer or union health coverage after the employment ends or after you lose coverage as a dependent of the covered employee. There may be reasons why you should take Part B instead of COBRA. However, if you take COBRA and it includes creditable prescription drug coverage, you will have a special enrollment period to join a Medicare drug plan without paying a penalty when the COBRA coverage ends.
Medicare supplement policies are no longer sold with prescription drug coverage. But if you have drug coverage under a current Medicare supplement policy, you can keep it. You may want to join a Medicare drug plan instead, because supplement drug coverage isn’t creditable. If you join a Medicare drug plan, your supplement insurance company must remove the prescription drug coverage and adjust your premiums. Call your Medicare supplement insurance company for more information.
If you join a Medicare drug plan, you can keep your FEHBP plan, and your plan will let you know who pays first. For more information, contact the Office of Personnel Management at 800-332-9798. You can also call your plan if you have questions.
You may be able to get prescription drug coverage through the U.S. Department of Veterans Affairs (VA) program. You may join a Medicare drug plan, but if you do, you can’t use both types of coverage for the same prescription. For more information, call the VA at 800-827-1000 (TTY call 800-829-4833).
People with TRICARE who are entitled to Part A must have Part B to keep TRICARE prescription drug benefits. If you have TRICARE, you aren’t required to join a Medicare drug plan. If you do, your Medicare drug plan pays first, and TRICARE pays second. If you join a Medicare Advantage plan with prescription drug coverage, TRICARE won’t pay for your prescription drugs. For more information, call the TRICARE pharmacy contractor at 877-363-8779 (TTY call 877-540-6261).
* Creditable - Creditable coverage is any coverage that is offered through an employer or group sponsored health plan, or some other health plan, that is equal or better than coverage you would receive under Medicare. Providing proof to Medicare that you have creditable coverage at the time you enroll will keep you from having to pay a late penalty fee if you enroll in prescription drug coverage after your initial open enrollment period.
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