Avoid late enrollment penalties (2024)

FAQs

How do I get rid of late enrollment penalty? ›

Part D Late Enrollment Penalty Reconsideration Request Form

An enrollee may use the form, “Part D LEP Reconsideration Request Form C2C” to request an appeal of a Late Enrollment Penalty decision. The enrollee must complete the form, sign it, and send it to the Independent Review Entity (IRE) as instructed in the form.

For each month you delay enrollment in Medicare Part D, you will have to pay a 1% Part D late enrollment penalty (LEP), unless you: Have creditable drug coverage. Qualify for the Extra Help program. Prove that you received inadequate information about whether your drug coverage was creditable.

You can sign up later without penalty, as long as you do it within eight months after your other coverage ends. If you don't qualify to delay Part B, you'll need to enroll during your Initial Enrollment Period to avoid paying the penalty.

The Medicare Part D late enrollment penalty is a surcharge added to your Medicare Part D (prescription drug plan) monthly premium. Medicare gives this penalty to people who don't sign up for Part D drug coverage before Medicare enrollment period deadlines.

It's likely that you can delay Medicare enrollment, but some employers require that people 65 and older must enroll in Medicare to receive company health insurance benefits. For these smaller companies with less employees, Medicare pays first, and work-based insurance pays second.

How much is the Part D penalty? The Part D penalty has no cap. The base beneficiary premium, calculated by the Centers for Medicare & Medicaid Services each year, is different from the national average Part D premium. For example: The national base beneficiary premium is $34.70 a month in 2024.

PHIL: Your employer is supposed to provide you a statement certifying whether or not the drug coverage in your plan is credible, compared with a Part D plan. Make sure you get that statement because it's going to protect you down the road if you have any differences of opinion.

Many people choose to keep working past 65 and keep their coverage under their employer's group plan. But if you've been paying into Medicare via payroll deductions, you may as well enroll in Original Medicare Part A (hospital insurance) when you're first eligible, as you'll pay no premium.

Medicare Part B Penalty Waiver Explained

The SEP gives you an eight-month period starting from when your employment or health plan coverage ends, allowing you to enroll without facing any penalties.

How to calculate Medicare Part B late enrollment penalties? ›

This penalty is equal to 10% for every year (12 full months) that you waited to enroll, and is added to your monthly premium. This penalty gets applied against the standard Part B premium. Keep in mind that the national Part B premium may change each year.

Generally, you're first eligible to sign up for Part A and Part B starting 3 months before you turn 65 and ending 3 months after you turn 65. Find out if: Your state will sign you up for Medicare (or if you need to sign up). Your Medicaid coverage will change after you're eligible for Medicare.

Appealing the LEP

If you do not have an appeal form, you can use SSA's request for reconsideration form. You can appeal to remove the penalty if you think you were continuously covered by Part B or job-based insurance.

If you go 63 days or more in a row without Medicare drug coverage or other creditable prescription drug coverage, you may have to pay a penalty if you sign up for Medicare drug coverage later.

What if your Medicare premium payment is late? If you miss a payment, or if we get your payment late, your next bill will also include a past due amount. If you get a Medicare premium bill that says “Delinquent Bill” at the top, pay the total amount due, or you'll lose your Medicare coverage.

You'll generally have to pay the penalty for as long as you have Medicare drug coverage. Learn how to avoid the late enrollment penalty.