Creditable Coverage Notice
When Will You Pay A Higher Premium (Penalty) To Join A Medicare Drug
You should also know that if you drop or lose your current coverage with Alliance 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
Contact the person listed below for further information.
You’ll get this notice each year.
You will also get it before the next period you can join a Medicare drug plan, and if this coverage
through Alliance changes. You also may request a copy of this notice at any time.
For More Information About Your Options Under Medicare Prescription
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:
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
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
or call them at 1-800-772-1213 (TTY: 1-800-325-0778)
Name of Entity/Sender:
Alliance Health and Life Insurance Company
Richard D. Chaney
Vice President, Client Services
2850 W. Grand Blvd, Detroit, MI 48202
Remember: Keep this Creditable Coverage notice. If you decide to join
one of the Medicare drug plans, you may be required to provide a copy
of this notice when you join to show whether or not you have
maintained creditable coverage and, therefore, whether or not you are
required to pay a higher premium (a penalty).