D Late Enrollment Penalty
The late enrollment penalty is an amount that’s permanently added to your Medicare drug coverage premium. You may owe a late enrollment penalty if at any time after your Initial Enrollment Period is over, there’s a period of 63 or more days in a row when you don’t have Medicare drug coverage or other
. Youll generally have to pay the penalty for as long as you have Medicare drug coverage.
, you don’t pay the late enrollment penalty.
Need Help Paying For Coverage
If youre delaying enrollment in Part B and/or Part D because you cant afford it, check to see if you qualify for help.
The Medicare Savings Programs and Extra Help program can provide financial help for various health care or prescription drug costs. Your income and assets determine if youre eligible. Assets include cash, savings and investment and vacation property.
Medicaid can help pay for Medicare premiums, deductibles, copays and/or coinsurance. Medicaid may cover services Original Medicare doesnt. For example, Medicaid can cover care in a designated nursing facility if you dont have money, assets or long-term care insurance to pay for it.
You may be dual eligible for Medicare and Medicaid and get a plan at reduced costs. In Minnesota, this type of plan is called Minnesota Senior Health Options . For no monthly premium, it covers medical, prescription drugs, dental, long-term care and other benefits and services.
Ways To Avoid Paying A Penalty
Also Check: What Does Medicare Cost Me
How Much Is The Late Fee
The Medicare Part D late enrollment penalty is 1 percent of the national base beneficiary premium for every month you were eligible for creditable drug coverage but did not have it.
The national base beneficiary premium can be thought of as the average Part D premium. While its not technically the average premium, its a close approximate. The national base beneficiary premium for 2022 has been set at $33.37 per month. The late enrollment penalty calculation is rounded to the nearest $0.10. So for 2022, the late enrollment penalty is 33 cents for every month you did not have creditable drug coverage.
33 cents? Whats the big deal? This is where the math gets interesting. The penalty is not just a one-time fee. You will have to pay the fee every month that you remain enrolled in Part D. That means if you are late to enroll in a Part D plan and then maintain Part D coverage for the next 20 years, youll be paying that late fee every single month for the next 20 years or more.
Here are some other examples to consider:
To make matters worse, the national base beneficiary premium typically changes every year. And the penalty you owe is not locked into the rate at which you first acquired your penalty. Its tied into the current years rate. If the national base beneficiary premium goes up, so too does your penalty.
The Truth About Paying The Medicare Part D Penalty
During a recent workshop with seniors at my church, a debate broke out concerning Medicare Part D.
Thats the program that helps pay for prescription drugs. Medicare offers the coverage to all enrollees, and if you elect to get it, you pay a monthly premium.
If you do not sign up for Part D when youre first eligible for Medicare Part A and/or Part B, and you didnt have prescription drug coverage that met Medicares minimum standard, you may have to pay a late enrollment penalty if you eventually decide to join the plan.
Some of the seniors, concerned about facing that penalty, said they had enrolled in Part D even though they already had drug coverage as part of another plan, some with their former employers.
Im not going to pay a penalty, one woman argued, with several others agreeing with her.
But another senior tried to tell her that she wouldnt face a penalty if she later needed Part D. He was right: You dont incur a late penalty if you opt out of getting Plan D because you already have creditable prescription coverage or if you participate in the government program called Extra Help.
The key word here is creditable, which means that your plans coverage is expected to pay on average as much as the standard Medicare prescription drug coverage. If you have drug coverage from an employer, union or other group health plan, you should get a notice every year letting you know whether your drug coverage is creditable.
Read Also: How Can I Sign Up For Medicare
Is There A Late Enrollment Penalty For A Medicare Supplement Plan
Thankfully, there are generally no late enrollment penalties for Medicare Supplement plans. Your enrollment period for a Medicare Supplement plan starts once you enroll in Part B and lasts for six months. While you wont have to pay a late enrollment penalty if you miss your Medicare Supplement open enrollment period, youll have to undergo medical underwriting when applying for your Medicare Supplement plans.
Thats where we come in. If you are in the process of enrolling in Medicare and youre looking to save as much money as possible and avoid late enrollment penalties, this is the time to enroll in a Medicare Supplement plan. Were here to guide you through the steps of enrollment and provide you with as much information as we can for all of your Medicare questions.
Take control of your health and dont get stuck with a penalty or a higher Medicare Supplement premium. Let us help. Our Medicare experts are here to guide you through the steps you need to take to secure your Medicare coverage, and answer any questions that you may have. You can reach us at . We look forward to helping you!
Nothing on this website should ever be used as a substitute for professional medical advice. You should always consult with your medical provider regarding diagnosis or treatment for a health condition, including decisions about the correct medication for your condition, as well as prior to undertaking any specific exercise or dietary routine.
Final Thoughts On Medicare Late Enrollment Penalty
Many people end up paying Medicare late enrollment penalty because they just didnt know the rules. You may be healthy at age 65 and feel you dont need Parts A, B or D. The penalties for such a mistake can add up to a great deal of money over time. Consult with a Medicare insurance broker like Boomer Benefits to ensure that you enroll in coverage when you are supposed to and minimize risk of penalties. Our service is free and we are happy to help you.
Inform Medicare About Prior Drug Coverage
When you join a Medicare prescription drug plan like Part D, you will receive a letter from the plan if it detects that you have gone at least 63 days in a row without creditable drug coverage. This letter provides a form to describe the drug coverage youve received in the 63-day period. Disregarding this letter may result in a penalty.
What If My Part D Late Enrollment Penalty Is A Mistake
As soon as you enroll in a Part D plan, Medicare audits your insurance history and checks for gaps over 63 days in your prescription drug coverage. If it suspects a gap exists, your drug plan will send you a form and request information. This form is your opportunity to correct your coverage-history mistakes, so don’t miss it. If you saved your notices about your drug plans creditability, you could send those with the form as well.
How To Avoid The Part D Penalty
There are three ways to avoid the Part D late penalty. The first, of course, is to join a Medicare drug plan as soon as you are eligible. Your Initial Enrollment Period consists of the three months before the month you turn 65, the month of your 65th birthday, and the three months following your 65th birthday.
The next way to avoid the penalty is to not go 63 days or more without creditable drug coverage. As long as you have creditable drug coverage, you qualify for an SEP once that coverage ends. The Special Enrollment Period lasts a full eight months for Medicare Parts A and B, but only 63 days for Part D. If you allow more than 63 days to pass, youll likely have a late penalty.
Finally, you can avoid the Part D penalty if you save the records that prove you had creditable drug coverage. Each year, your plan should send you a statement that your coverage is creditable. When you sign up for Part D, tell your plan about your previous coverage. Failure to do so may result in a penalty.
The Right Medicare Plan Can Save You Hundreds Of Dollars Each Month
See your options to find savings.
What You Need to KnowMedicare beneficiaries still face a coverage gap for…
Updated: October 10th, 2021ByKate Ashford×
We do not sell insurance products, but there may be forms that will connect you with partners of healthcare.com who do sell insurance products. You may submit your information through this form, or call 855-617-1871 to speak directly with licensed enrollers who will provide advice specific to your situation. Read about your data and privacy.
Our mission is to provide information that will help everyday people make better decisions about buying and keeping their health coverage. Our editorial staff is comprised of industry professionals and experts on the ACA, private health insurance markets, and government policy. Learn more about our content.
Read Also: How Much Can I Make On Medicare
Continuous Drug Coverage: More Than Just Avoiding A Penalty
When you’re first eligible for Medicare, you can pick from among any of the Part D plans available in your area . If you’re perfectly healthy and not taking any prescriptions, you might be tempted to skip Part D in order to avoid the monthly premium. As you can see from the penalty examples above, that could end up being a costly mistake if you later have to pay a late enrollment penalty for the rest of your life.
But it’s also important to understand that skipping Part D when you’re first eligibleassuming you don’t have other creditable coverage in placecould put you in a more immediate bind if you end up being diagnosed with a condition that requires costly medications. That’s because you generally won’t be able to sign up for Part D outside of the annual enrollment window each fall. So let’s say you skip Part D initially, and then a few years later, in February, you get diagnosed with MS or cancer or rheumatoid arthritis or some other condition that requires expensive medications. Yes, you’re going to have to pay the Part D late enrollment penalty once you eventually enroll. But the more pressing concern is the fact that you will have to wait until the following January to have outpatient drug coverage. You’ll be able to sign up in the fall, and your plan will take effect in January, but you’ll be on your own to pay for your medications for 11 months.
Here Are The Medicare Rules You Must Follow
InvestopediaForbes AdvisorThe Motley Fool, CredibleInsider
Medicare imposes premium penalties on people who dont follow the programs health insurance coverage rules. You can avoid Part D penalties by signing up when you first become eligible. But not everyone needs Medicare at age 65. The most common reason? You still have coverage through work.
If you have the privilege of postponing your Part D enrollment because you have a better prescription coverage option, youll need to pay special attention to how to avoid penalties later. If you make a mistake and go too long without signing up, youll have to pay premium penalties every month for as long as you stay on Medicarewhich could be 20 years or longer.
Also Check: Does Costco Pharmacy Accept Medicare
How To Avoid Medicare Enrollment Penalty
Did you know there is a late enrollment penalty for Medicare?
No one likes to pay penalties, fines, or fees. Especially when it is something you could avoid.
In this article, we are going to explain what the Medicare penalty is and why there is one. We will also tell you how to avoid the Medicare enrollment penalty.
How To Avoid Medicare Late Enrollment Penalties
Enrolling for Medicare and making the right plan selection is a big decision. While it is important to weigh all your options, failure to get coverage on time can lead to penalties that increase Medicare costs over time. Medicare late enrollment penalties can catch people off guard, which is why you should be aware of how to avoid these costly premium penalties.
Medicare has four parts, but not all of them have late enrollment penalties. A person can face late enrollment penalties for Medicare Part A, Part B, and Part D if they fail to enroll for Medicare during the Initial Enrollment Period and dont qualify for a Special Enrollment Period .
The IEP spans seven months total: three full months before your 65th birthday, the entire month in which you turn 65, and three full months after your birthday month. For example, if youre 65th birthday is on June 9th, your IEP would begin on March 1st and end on September 30th.
If you miss the IEP, youre eligible to enroll for coverage typically without penalties if you qualify for an SEP. Certain events make people eligible for coverage during an SEP, including:
- Working past 65 and covered by an employer
- Moving outside of current plan coverage area
- Losing current coverage
- An opportunity to get other coverage
- A plan changes its contract with Medicare
- Additional special circumstances
If you happen to forget to sign up during the IEP or SEP, these are the late enrollment penalties you will face.
You May Like: Is Silver Sneakers Part Of Medicare
When Does The Part B Penalty Not Apply
Those that miss the enrollment deadline but end up signing up during the next General Enrollment Period within fewer than 12 full months wont pay a penalty. So, if the Initial Enrollment Period ends on June 30, only 9 months will have passed before the end of the General Enrollment Period on March 31.
Also, those under age 65 with Medicare disability and paying a Part B late enrollment penalty wont pay the penalty after turning 65. Further, those with Medicaid wont worry about Part B premiums and penalties since the state pays those.
Finally, anyone living outside the United States that doesnt get premium-free Part A, cant enroll in Part A or Part B abroad. But, these people will get a Special Enrollment Period for three months after returning to the United States.
Enrolling during those three months means youre not liable for late penalties. You may also be able to qualify for equitable relief if a federal employee told you that you didnt need to sign up for Part B when you were supposed to enroll.
Medicare Part B Late Enrollment Penalty
Much like Part A, many people receive automatic enrollment in Part B. This is most likely the case if you are already receiving Social Security or Rail Road Retirement Benefits. If you are not automatically enrolled in Part B, we encourage you to enroll when you first become eligible. If you wait too long, you might have to pay the Medicare Part B late enrollment penalty.
Unlike Part A, youll typically have to pay a Part B penalty for as long as you have Part B. Your penalty has the potential to increase up to 10% for every year you were eligible but did not sign up.
Lets give another example. Say you were eligible for Part B for four years before you decided to sign up. In that scenario, the cost of your penalty would be 40% of your monthly premium. Medicare may add add this amount to your Medicare Part B monthly premium.Remember: Part B is completely elective. Youre not required to enroll in Part B, but we do encourage you to enroll so you have coverage for outpatient medical services.
You May Like: Is Dexcom G6 Cgm Covered By Medicare