Medicare Part D Late Enrollment Penalty

If you’re enrolling in Medicare, you may question whether you really need Part D prescription drug coverage. Beneficiaries pay a monthly premium for Part D, it may feel like an unnecessary expense if you don’t take any prescriptions. You may have other prescription benefits and wonder if you need Part D.

Skipping Part D coverage can be an expensive decision, depending on your situation. You may find yourself without insurance to cover medications if you suddenly become ill.

Then, when you finally do enroll, you may pay a Medicare Part D late enrollment penalty. This will be in the form of a higher premium for as long as you have Part D.

What is the Medicare Part D Late Enrollment Penalty

When you first become eligible for Medicare, you have an Initial Enrollment Period to sign up for coverage, including Part D.

If you’re eligible because you are turning 65, your Initial Enrollment Period begins three months before your 65th birthday month and ends three months after your birthday month.

After that IEP, you’ll pay a Part D late penalty if you go without one of these types of drug plans for 63 days or more:

A Part D plan
Prescription coverage through a Medicare Advantage plan
Any other Medicare plan that includes Medicare PDP coverage
Another healthcare plan that includes prescription drug coverage that is at least as good as the coverage provided by Medicare.

Medicare Part D Late Enrollment Penalty Calculator

The Medicare Part D penalty is based on the number of months you went without PDP coverage. For each month without coverage, you will pay an additional premium of 1 percent of the current “national base beneficiary premium.”

For 2020, the average beneficiary premium is $32.74.

This is not a one-time penalty. You’ll pay it every month for as long as you have Medicare prescription coverage. Your Part D penalty will be rounded to the nearest $.10 and added to your Part D premium.

Since the penalty is always based on the current year’s national beneficiary premium, it may change or go up each year.

Part D late enrollment penalty calculation can be hard to figure out. So, here’s an example to show how this works.

Suppose your Initial Enrollment Period ended and you waited 33 months to sign up for Part D. Your Part D penalty would be 33 percent of the national beneficiary premium, one percent for each of the 33 months you waited.

This would be calculated as $32.74 x .33 = $10.80. The Part D penalty is rounded to the nearest 10 cents.

You’ll pay this penalty in addition to your Part D Premium. The best way to avoid paying the Part D late enrollment penalty is to enroll in a Prescription Drug plan as soon as you become Medicare eligible.

FAQ’s

What is the Part D penalty cap?

Since this penalty didn’t start until 2006, you can only be penalized starting from that year. The capped amount of months increases each month. So as of January 2020, the cap is 163 months. Which means you cannot be penalized more than $54.10.

Amplicare has a great Part D penalty calculator.

Are there other drawbacks to waiting to enroll in a Part D plan?

You can’t just enroll in Part D whenever you want. After your initial enrollment period ends, you can usually only enroll during the Annual Enrollment Period that runs from October 15th to December 7th each year.

That means that if you wait to sign up for Part D, you may find yourself paying full price for expensive medications if you suddenly become ill. It’s better to have coverage before you need it; you wouldn’t buy car insurance after a car accident, so, don’t wait to buy prescription coverage.

What if I already have Prescription Drug Coverage?

If you already have coverage through an employer, union, or another source, you may not have to worry about the Part D penalty. The key is whether the coverage you now have is “creditable”. Creditable coverage is the same as, or better than, the benefits Medicare provides.

You will not accumulate any penalties during the time you have other creditable coverage. If you lose this coverage through no fault of your own, you should be eligible for a Special Enrollment Period. When you sign up within 63 days of losing coverage, you will not have to pay penalties.

You should receive a notice each year saying whether your coverage is creditable. Save this letter with your important papers – you may have to show it to Medicare to avoid a penalty.

Medicare Part D Late Enrollment Penalty Reconsideration

If you’re penalized by Medicare, you can appeal it. All you must do is complete a reconsideration request form that’s available on CMS.gov.

If you qualify for extra help, you may qualify for assistance paying the Part D penalty. Some lower-income beneficiaries have the penalty waived altogether. You can contact Social Security to apply for Medicare Extra Help.

2 Comments

uncle amos says:

May 18, 2020 at 10:32 am

All these articles are written by insurance agents with skin in the game. I will skip part D until I need it. I have not filled a prescription in decades. The penalty is peanuts. YMMV

- Lindsay Engle says:
  
  May 18, 2020 at 11:38 am
  
  Hello! No, agents do not write our content. The penalty may not be a lot for some, but if you wait ten years to enroll, the penalty can quickly add up for some.

What is the Medicare Part D Late Enrollment Penalty

Medicare Part D Late Enrollment Penalty Calculator

FAQ’s

Medicare Part D Late Enrollment Penalty Reconsideration

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Lindsay Engle

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