Part D Penalties ~ What Are They & Can They Be Avoided?

Part D Penalties ~ What Are They & Can They Be Avoided?

Nobody likes penalties, especially when it means paying more money. When it comes to Medicare, most people can avoid penalties by enrolling in Parts A, B and D when first eligible, during their Initial Enrollment Period. Those who don’t enroll during this time, may have a penalty. The IEP is different for different parts of Medicare. This article reviews the Part D late enrollment penalty (LEP) and exceptions.

Unlike Part A and B late enrollment penalties that don’t start until someone has delayed enrollment for 12 or more months, the Part D LEP begins accruing 63 days after one’s initial enrollment period has ended. The penalty amount varies depending on how long one delays enrolling in Part D after becoming eligible. To calculate the cost, Medicare multiplies 1% of the national average Part D premium ($34.10 in 2016) by the number of months without coverage. And this penalty is paid for eternity….well, not exactly, but the point is the penalty stays and one will pay it as long as s/he has Part D coverage.

Are there exceptions?

Yes, there are a couple of exceptions. The LEP is waived if you had “creditable drug coverage” during the months of delayed enrollment. To be considered creditable, the coverage must be at least as good as Medicare’s standard drug coverage. This could be coverage from an employer, union, TRICARE, Veterans Affairs, Indian Health Services or a Medicare Advantage plan with drug coverage. Each year you should receive a letter from your health plan stating that your coverage is creditable. Hold onto this letter. You may need it if you sign up for Part D at a later time.

Another exception is for people who qualify for the Part D low-income subsidy, known as Extra Help that covers most premium and deductible costs. Those who qualify do not have to pay a penalty, regardless of how long they didn’t have drug coverage.

See Prescription Drugs for more information on Medicare Part D, and our section on late enrollment penalties for more info on Part A and B LEPs.

Our blogger Karen J. Fletcher is CHA's publications consultant. She provides technical expertise, writing and research on Medicare, health disparities and other health care issues. With a Masters in Public Health from UC Berkeley, she serves in health advocacy as a trainer and consultant. See her current articles.

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