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Not everyone who’s eligible for Medicare chooses to enroll in Part D. There are alternative prescription drug coverage options you can choose instead. But the coverage needs to be considered creditable, or you may incur a lifetime penalty.

Here’s what you need to know about creditable coverage, including what it means, how to tell if your plan qualifies and more.

Who needs to understand creditable coverage

All current and upcoming Medicare beneficiaries should understand how creditable coverage works, including:

• Seniors soon to turn 65
• People eligible for Medicare due to disability or end-stage renal disease
• Retirees looking to keep their employer-sponsored drug coverage or enroll in Part D

It’s also important that employers, plan sponsors, HR, or benefit professionals understand creditable coverage, so they can remain in compliance.

What is creditable coverage?

To be considered creditable, a prescription drug plan must pay at least as much for prescription drugs as Medicare Part D. Creditable coverage can come from multiple sources, including:

• Current or former employer-sponsored health plans
• Union plans
• Retiree health plans
• Government programs like TRICARE, the Indian Health Service (IHS) or the Department of Veterans Affairs (VA)

Why creditable coverage is important

Once you become eligible for Medicare, you can enroll in Part D prescription drug coverage. Enrolling is optional, but if you choose not to do so within the first 63 days of eligibility, Medicare applies a permanent late enrollment penalty.

Those already enrolled in a plan with creditable drug coverage have more flexibility. They can remain on the plan and enroll in Part D in the future without penalties.

Is creditable coverage required?

No. However, having creditable coverage will help you avoid Part D penalties down the line when you enroll in Medicare.

How to know if your coverage is creditable

Plan sponsors, like an employer, are legally required to share with plan members whether coverage is considered creditable. This often occurs annually with a notice of creditable coverage. Typically, this document is sent out before Oct. 15, when Medicare’s Annual Enrollment Period (AEP) begins. You may also receive this notice when you first join your plan, when coverage status changes or if you request it from your health plan.

How creditable coverage is determined

The Centers for Medicaid & Medicare Services (CMS) manages creditable coverage rules, definitions and standards. CMS determines whether a plan’s coverage is creditable based on drug benefit value, cost-sharing amounts, plan payments and more.

Medicare is updated each year based on economic, medical and other developments. When Medicare changes, CMS may adjust what qualifies as creditable.

Can a plan’s creditable coverage status change?

Yes. Yearly updates to your plan’s drug coverage or Medicare Part D can cause the creditable coverage status of a plan to change when it’s evaluated for renewal.

What happens if you lose creditable coverage

If your plan’s status changes or you lose coverage, you may qualify for a special enrollment period (SEP). During this time, you can enroll in Medicare Part D. Like the Initial Enrollment Period, this enrollment window is open for 63 days.

Are members notified when coverage changes?

Yes, if you are enrolled in a plan that includes prescription drug coverage, each year you will receive a creditable coverage or non-creditable coverage notice from your health plan or employer.

What employers should know about creditable coverage

Employers should review their plan’s status and take action to remain compliant. If a plan is no longer creditable, employers are required to notify all employees and maintain necessary documentation.

A surprisingly common query I get is colostrum vs. collagen—which is better? Maybe it’s the fact that they both start with the same three letters. Maybe it’s that they’re both alternative health darlings currently enjoying a huge uptick in interest.

Whatever the reason for their connection in people’s minds, I thought it would be a good idea to do a quick write-up on how colostrum and collagen might interact in the body, what the relative benefits are, and whether you can take them both together.

Let’s dive right in.

Contrary to what the influencers might tell you, there isn’t a ton of research showing that bovine colostrum has a wide range of benefits for adults. It’s definitely helpful for newborns, since their guts are incredibly permeable, and colostrum is literally the first food they’re supposed to eat. Even cow colostrum has been shown to improve outcomes for newborns and premature infants. No arguments there.

But I’d caution against expecting too much from colostrum supplements. The best case for adding it to your diet as an adult is improving gut health, reducing intestinal permeability, and improving immune function—particularly for athletes.

Colostrum has been heavily researched for its ability to reduce gut permeability in various populations, including athletes, medical patients, and everyday folks.1-4 People who take bovine colostrum supplements often report better gut health and a more intact gut lining. Zonulin, a gut compound that increases permeability, frequently drops with colostrum intake.

Researchers aren’t entirely sure how bovine colostrum benefits the gut. Some people claim it regulates specific growth factors in the gut lining that help repair and support its structure. That’s colostrum’s primary role in infancy: improving gut viability so the immune system can develop, enabling digestion of food instead of relying on the womb for sustenance. Thanks in large part to colostrum benefits, this new member of the human race is able to handle what the world throws at it and develop a healthy immune response and gut lining

The challenge is that the adult gut isn’t as permeable as a newborn’s by design. For instance, the IGF-1 in bovine colostrum isn’t absorbed or utilized by adults.5

Colostrum can also regulate inflammation and help maintain iron balance in athletes, largely due to its lactoferrin content.6 Lactoferrin is an immune protein that improves iron absorption while reducing free iron—an inflammatory agent—circulating in the body. Athletes taking colostrum for instance see higher spikes in inflammation during workouts but lower resting inflammation, showing it promotes “smart” inflammation.

Meanwhile, collagen benefits for gut health are much more direct. Collagen provides the actual building blocks—amino acids like glycine—for repairing and growing the gut lining. Whether it turns out that colostrum does indeed trigger growth factors that help the gut repair itself (by no means confirmed), or if it just lowers inflammation via lactoferrin which allows the repair to proceed, you’ll need extra collagen to make those repairs.

Colostrum assists with gut repair while collagen provides a substrate required for the repair to occur.

And so the two compounds are not competing with each other, but potentially complementary. Both colostrum and collagen improve gut health, enhance skin health and appearance, and boost immune function by different but complementary routes.

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Yes, you can absolutely take collagen and colostrum together. In fact, I’d argue that if colostrum works, they’re almost made for each other. You don’t need to mix them in the same shake or take them simultaneously; just include both in your routine for maximum benefit.

Adding both colostrum and collagen supplements can create a synergistic effect, particularly for gut and immune health. Collagen serves as the substrate, while colostrum provides potential activation via growth factors.

It depends on your dietary needs. If you only take one, take collagen. Collagen is like the fourth macronutrient, providing glycine—an amino acid we no longer get enough of in modern diets. This makes collagen essential for maintaining skin, bones, blood vessels, and more. It’s also widely beneficial, whether you’re looking for joint health, anti-aging, or gut support.

If you regularly consume foods like bone broth, gelatinous meats, or stews, you may already be getting plenty of collagen. In that case, colostrum supplements could add more value, especially for individuals with immune or gut issues that dietary changes haven’t resolved.

Colostrum, derived from the mature milk of cows after giving birth, is essentially absent from the diet unless you specifically seek it out. It’s best suited for people dealing with gut inflammation or immune dysregulation. Athletes might benefit from colostrum’s ability to regulate iron and inflammation, while others may see improved resistance to respiratory infections.

Who should take collagen?

Everyone.

Who should take colostrum?

• Athletes with iron balance issues.

• Adults prone to upper respiratory tract infections.

• Individuals with leaky gut or gut inflammation.

If you’re on a budget, you can likely replicate most of the colostrum supplement benefits with a high-quality whey isolate (which contains some lactoferrin, but not as much as colostrum) and a dedicated lactoferrin supplement. My guess is that lactoferrin is doing much of the heavy lifting for colostrum’s benefits.

Both colostrum and collagen offer unique benefits, but collagen stands out as the more universally essential supplement. Its role in collagen production, gut lining repair, and overall health makes it indispensable for most people. Bovine colostrum can complement collagen, especially in specific scenarios, but it isn’t as necessary or widely applicable.

For most, collagen is the clear winner. Still, if you have unique needs or simply want to experiment with bovine colostrum benefits, adding both to your regimen can offer the best of both worlds.

1. https://pmc.ncbi.nlm.nih.gov/articles/PMC9227274/

2. https://pubmed.ncbi.nlm.nih.gov/38361147/

3. https://pmc.ncbi.nlm.nih.gov/articles/PMC5409709/

4. https://pubmed.ncbi.nlm.nih.gov/41226709/

5. https://pubmed.ncbi.nlm.nih.gov/31123862/

6. https://pmc.ncbi.nlm.nih.gov/articles/PMC9824210/

Mark’s Daily Apple is still under construction. My team and I are actively working to repost the archives. Check back regularly to find posts that are new to you and revisit old favorites. Looking for a specific post? Let us know here.

You can help more people find us by spreading the word:

Share Mark’s Daily Apple

* This blog reflects my personal views and opinions and isn’t intended as medical advice, but I hope it will be informative and inspiring as you pursue a healthy, fulfilling life.

Testosterone is a hot topic for men of all ages. After all, it supports lean muscle mass, energy and sex drive (among many other things). But whether so-called “testosterone boosting” supplements can help you see greater levels of these benefits is a different story.

For one thing, testosterone isn’t necessarily a “the more, the merrier” hormone. On top of that, taking a supposed testosterone booster is not the same as getting clinically supervised treatments for low testosterone. Below, we explain what you need to know about supplements that claim to boost testosterone, including what the research says, what you should do if you’re interested in taking one and more.

There’s a big difference between “testosterone boosting” supplements and testosterone therapy

Supplements that primarily market themselves as boosting men’s testosterone, libido, or energy may not actually deliver on what they claim. This is because supplements aren’t regulated by the Food and Drug Administration (FDA), so manufacturers don’t have to prove their safety or efficacy.

As a result, many “T-boosters” contain somewhat random dosages of multiple ingredients, each with varying levels of supporting research. One study of 50 such supplements found that only 25% had data to support their claims, and 10% actually had the potential to decrease testosterone.

By comparison, testosterone therapy is a proven treatment, at least for men with measurably lower levels of testosterone than expected for their age, with related symptoms. Even in these cases, treatment involves ongoing monitoring for negative side effects. For example, there’s a high risk of male infertility with the use of testosterone and certain booster supplementation, which can sometimes be permanent.

Some individual supplements may increase testosterone, but more context is needed

In contrast to multi-ingredient T-boosters, supplemental forms of certain individual herbs and nutrients have shown potential for increasing testosterone. However, many of them have not been studied enough to be proven safe for long-term use, and using them still means buying an unregulated product.

For vitamins and minerals specifically, taking supplemental forms can also cause you to get far more than your body needs. In some cases, this can result in negative side effects like nausea, headaches or dizziness. So if a vitamin or mineral supplement interests you, it’s generally better to start by trying to get more of it through the foods you eat.

In addition, you have your own unique combination of factors that influence your health, which can have an impact on how different supplements affect you. Because of this, it’s important to talk with a doctor before starting a supplement, and to only consider ones that have research behind them, such as:

• Ashwagandh – A traditional Ayurvedic herb, ashwagandha has been shown to support testosterone and other markers of male fertility, possibly by reducing stress and improving sleep quality.
• Dehydroepiandrosterone (DHEA – DHEA is a hormone that the body uses to make other hormones. It has been studied as a potential alternative to testosterone supplementation, with limited, mixed results.
• Fenugreek – Used in cooking for the maple-like flavor of its seeds, fenugreek may improve testosterone levels. The exact mechanism isn’t known, but it has been shown to enhance exercise performance and related outcomes.
• Maca – Grown in the Andes mountains, studies have found maca root to have many health benefits, with increased testosterone among them.
• Tribulus – Extract of the highly invasive puncture vine has undergone a number of studies for its potential effects on men’s health. While there’s no solid evidence that it increases testosterone, it has been shown to improve erectile function.
• Vitamin B6 – Found in tuna, salmon, chickpeas, poultry and leafy greens, vitamin B6 indirectly supports testosterone production and regulation in a variety of ways.
• Vitamin D – Although research is ongoing, studies suggest that vitamin D deficiency may negatively impact testosterone levels. Vitamin D is found in fatty fish, egg yolks, cheese, and fortified milks and cereals.
• Zinc – Found in seafood, meat, eggs, nuts, whole grains and dairy, zinc plays a key role in testosterone production.

Improving overall health can boost testosterone naturally

Although supplements like the above may have a positive effect on testosterone, they’re not a shortcut. Whether you’re a younger man trying to maximize muscle growth or an older man looking to maintain energy and slow natural age-related hormone changes, optimizing your overall health through the usual, “boring” routes is going to be necessary if you want the best possible results.

Take steps to manage chronic health conditions

Certain health conditions like obesity and diabetes are associated with lower testosterone levels. Obesity can negatively affect the pituitary gland or hypothalamus, which tell the testicles to produce testosterone. And diabetes impacts the pancreas’ ability to regulate blood sugar, which can also disrupt other hormones’ production processes including testosterone.

If you’re living with one of these conditions, working with your doctor to manage it is key to maintaining a healthy balance of hormones. Obesity in particular is one of the most reversible causes of low testosterone.

Get consistent moderate to high-intensity resistance and cardiovascular training

Moderate-to-intense resistance training (i.e., weightlifting) and high-intensity interval training have been shown to boost testosterone levels temporarily after completion. This doesn’t translate into long-term elevated levels, but completing 3-4 such workouts per week still supports testosterone indirectly by helping to regulate hormones, and build and maintain lean body mass. This is especially helpful for people with obesity or diabetes.

Moderate-intensity aerobic training like jogging, biking or swimming also helps reduce body fat and supports heart health, which is important for reducing potential low testosterone symptoms like erectile dysfunction.

Eat a balanced, whole foods-based diet

A balanced diet of lean proteins, healthy fats, fruits and vegetables helps your body produce a healthy balance of hormones. Whole foods are also more nutrient-dense and calorically efficient compared to processed foods, which can make it easier to maintain lean body mass.

Reduce or eliminate alcohol and nicotine

Excessive alcohol consumption and nicotine use can both negatively affect testosterone levels, sexual health and fertility.

Manage stress and get high-quality sleep

Stress and poor sleep have both been linked to decreased testosterone production. Getting consistent exercise is one way to help with these, but practicing good sleep hygiene and mindfulness techniques like meditation can also have benefits. Additionally, if you have a health condition like sleep apnea, working with a doctor to manage it is important. Sleep apnea can negatively affect testosterone levels by interrupting nighttime hormone production, and in some cases, testosterone therapy can make sleep apnea worse.

Avoid environmental toxins

Chemicals like bisphenol A (BPA) and phthalates that are used in some plastic food containers and cans have been found to disrupt hormone production. Research on the safety of different exposure levels is ongoing, but if you want to play it safe, look for packaging and containers that label themselves as free of these chemicals, and don’t heat up food in plastic. Eating a whole foods-based diet can also help with this by reducing the amount of packaging your food comes in.

If you think you might benefit from a testosterone boost, talk with a men’s health expert

If you’re interested in taking a supplement or are experiencing possible symptoms of low testosterone like fatigue, reduced sexual desire or erectile dysfunction, your primary care doctor is a great place to start. They can assess your goals, symptoms and overall health, make initial recommendations and connect you with a sexual health expert or another specialist if necessary.

At HealthPartners, you also have the option of scheduling an appointment directly with a sexual health expert. We don’t require a doctor’s referral before scheduling, but you should still check with your insurance plan to know your coverage for specialty care.

Yes and no.

Keto dieting’s popularity rose and peaked in the late 20-teens, declined for a few years, and has more or less held steady since 2023. So says Google Trends anyway. During the keto heyday, it felt like every time I went to the grocery store there were a dozen new products proclaiming “KETO” on the label. Most of the reader questions sent my way had to do with troubleshooting their keto diets. For a while, it was the topic I covered most frequently on the blog—what to eat and avoid, how to supplement, how to make it work for specific populations.

Not so much anymore.

But don’t be fooled. Although keto is no longer front and center in most diet and weight loss conversations—that distinction goes to GLP-1s—people are still discovering keto diets and trying them for themselves. Plenty of folks, including friends of mine, have been keto for many years, some even predating the keto boom. New books are still being written. Bloggers are still putting out keto recipe guides.

Keto is here to stay. It just looks a little different, as I say in the video.

Remember, the liver starts producing ketones when insulin is low and liver glycogen becomes depleted. Many roads lead to this outcome. Any way of eating that restricts daily carb intake below about 50 grams per day will trigger ketosis. Intermittent fasting paired with a Primal-style diet could do it. Carnivore diets can do it. Even a moderately low-carb diet paired with long or intense training sessions can do it. I’d wager that a fair number of you reading this are in ketosis at least some of the time, whether or not you’re intentionally following a keto diet. I’m sure I am too, although I don’t measure my ketone levels.

I still believe that keto is one of the best tools any of us have in our metabolic toolboxes for losing weight, tackling insulin resistance, and building that all-important metabolic flexibility.

I don’t really care how someone chooses to label their way of eating as long as it works for them.

In some ways, it is good that keto flies more under the radar now. At the height of its popularity, keto attracted a lot of negative press. (Paleo got the same treatment when it became popular 20 years ago. People love to bash anything that flouts conventional wisdom and asks them to give up their morning donuts and 500 calorie latte treats.) Now folks are free to try it without hearing every day about how it keto is a dangerous fad diet (it’s not) that will make their heart or kidneys explode (it won’t).

If you’re interested in exploring keto and trying a Keto Reset, the Primal method of approaching a keto diet, start here:

Let me know, have you tried keto in the past? Are you still doing it? Why or why not?

Mark’s Daily Apple is still under construction. My team and I are actively working to repost the archives. Check back regularly to find posts that are new to you and revisit old favorites. Looking for a specific post? Let us know here.

You can help more people find us by spreading the word:

Share Mark’s Daily Apple

* This blog reflects my personal views and opinions and isn’t intended as medical advice, but I hope it will be informative and inspiring as you pursue a healthy, fulfilling life.

We’re all supposed to eat a “healthy diet,” but what does that really mean? Off the bat, you probably think getting enough about protein and fatty acids (notably the vital omega-3s), plus important vitamins and minerals. But there’s also the less obvious: things like prebiotics and, the topic of today’s post, antioxidants.

Antioxidants, as I’ve discussed previously, defend the body from free radical damage. Free radicals are unstable molecules that knock around, pillaging electrons from other molecules and causing DNA damage and oxidative stress. When free radicals run amok, the damage they cause contributes to premature aging and chronic diseases. Antioxidants’ job is to limit free radical formation and neutralize them when their numbers become too great.

Plant and animal foods deliver important antioxidant vitamins, minerals, flavonoids, carotenoids, and other substances that the body can’t produce itself. To cover your antioxidant bases, since there’s no way to avoid free radicals, here are some antioxidant-rich foods to include in your diet.

Certain antioxidants are fairly easy to quantify. You can use any food tracking app to look up the amounts of antioxidant vitamins A, C, and E you consume in a day. Others, like antioxidant enzymes, are considerably more complicated. Scientists have devised various methods of measuring the total antioxidant capacity of food. You have your crocin bleaching assay (CBA), trolox equivalent antioxidant capacity (TEAC), total oxyradical scavenging capacity assay (TOSC), ferric reducing antioxidant potential (FRAP), DPPH assay, and many more.1

Don’t worry, there won’t be a quiz later.

ORAC, or oxygen radical absorbance capacity, was developed by scientists at the National Institute on Aging in 1992. Despite its popularity, the USDA renounced ORAC in 2012, on the grounds that ORAC doesn’t necessarily predict how much antioxidant activity happens in the body and to discourage supplement manufacturers from making strong claims about the power of their antioxidant formulations.

Nevertheless, researchers continue to use ORAC, and it remains the best way for the average person to look up which foods have relatively higher or lower antioxidant content.

The question of whether these foods actually supercharge your body’s ability to fight free radicals is still up for debate. A lot of factors probably go into it, including how much of these compounds you absorb and the freshness of the food you consume.

As I see it, the best reason to consider antioxidant values is that you’ll probably end up revisiting some otherwise nutritious foods you might not be eating regularly.

The foods that tend to score highly on antioxidant metrics are also ones that are widely considered healthy by other standards—colorful vegetables and fruits, organ meat, and seafood.

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Plant foods tend to be higher in antioxidants than animal products, though the latter are still important for checking certain antioxidant boxes. “Eating the rainbow” will net you a good spectrum of vitamins, minerals, and other antioxidants. You can also intentionally add high-antioxidant foods in the mix.

Here are 12 plant-based foods and beverages that can boost your antioxidant intake (based on a combination of ORAC and FRAP scores):

1. Berries

2. Coffee

3. Chocolate (the darker the better)

4. Chia seeds

5. Artichokes

6. Plums and prunes

7. Pistachios

8. Pomegranate

9. Figs

10. Kalamata olives

11. Kale

12. Green tea

If you’re lucky enough to have dog rose berries or rowanberry in your area, definitely include those as well.

On an absolute basis, the antioxidant capacity of these foods is lower than the plant foods above. However, these animal foods are among the best sources of the trace minerals copper, selenium, iron, manganese, and zinc, plus other antioxidants like lutein that are crucial pieces of the body’s antioxidant defense system.

1. Liver

2. Oysters

3. Salmon

4. Crab

5. Lamb

6. Beef

7. Eggs

8. Mussels

9. Tuna

10. Sardines

What say you? Do you think about antioxidants when putting together your meal plan, or is that not really a consideration for you? What are your favorite high-antioxidant foods?

1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8347950/

Mark’s Daily Apple is still under construction. My team and I are actively working to repost the archives. Check back regularly to find posts that are new to you and revisit old favorites. Looking for a specific post? Let us know here.

You can help more people find us by spreading the word:

Share Mark’s Daily Apple

* This blog reflects my personal views and opinions and isn’t intended as medical advice, but I hope it will be informative and inspiring as you pursue a healthy, fulfilling life.