Medicare Has Late Enrollment Penalties

Medicare Part A, Part B, and Part D all have late enrollment penalties for not signing up when you first become eligible.

That means you could end up paying more for life if you don’t sign up when you first become eligible.

Let’s cover the different rules for each type of Late Enrollment Penalty (LEP) to find out how each penalty works.

Part A Late Enrollment Penalty

You’ll owe a late enrollment penalty for Medicare Part A under these conditions:

If you don’t qualify for Premium-free Part A and don’t enroll in Part A when you’re first eligible for Medicare.

What happens if you don’t buy Part A when you are first eligible:

Your monthly premium may go up by 10%. You’ll have to pay the penalty for twice the number of years you didn’t sign up.

Notes:

  • In most cases, you won’t have to pay a Part A penalty if you qualify for a Special Enrollment Period.
  • You won’t owe the Part A premium if you delayed Part A due to having medical insurance through you or your spouse’s work and have earned 40 work credits by the time you enroll.
  • You won’t owe the Part A premium if you are part of Medicaid or your state pays your Part A premiums under one of the Medicare Savings Programs,
  • You qualify for special enrollment if you live abroad. You won’t owe the penalty if you enroll in Part A within three months of returning to the US.
  • You have the right to file an appeal with the Social Security Administration (SSA) regarding your LEP determination.
  • Part B Late Enrollment Penalty

Part B Late Enrollment Penalty

You’ll owe a late enrollment penalty for Medicare Part B under these conditions:

If you don’t enroll in Medicare Part B when you first become eligible.

What happens if you don’t buy Part B when first eligible:

You have to pay an extra 10% of your Part B premium for each full year you don’t enroll in Medicare Part B.

Notes:

  • In most cases, you won’t have to pay a Part B penalty if you qualify for a Special Enrollment Period.
  • If you go less than 12 months without Part B, you won’t owe the penalty. You can achieve this by enrolling in the next General Enrollment Period (GEP), which runs from January 1 to March 31 each year.
  • If you are younger than 65, have Medicare because of a disability, and are paying Part B late penalties, you won’t pay them after you turn 65.
  • You won’t owe the Part B premium if you are part of Medicaid or your state pays your Part B premiums under one of the Medicare Savings Programs,
  • You qualify for special enrollment if you live abroad. You won’t owe the penalty if you enroll in Part B within three months of returning to the US.
  • You have the right to file an appeal with the Social Security Administration (SSA) regarding your Part B LEP determination.

Part D Late Enrollment Penalty

You’ll owe a late enrollment penalty for Medicare Part D under these conditions:

If you go 63 days or more without creditable drug coverage.

What happens if you don’t buy Part D when first eligible:

You’ll pay an extra 1% of the “national base beneficiary premium” for each month (12% a year) you go without drug coverage.

Notes:

  • You won’t have to pay the penalty if you have other creditable drug coverage or qualify for Extra Help.
  • If you go less than 12 months without Part B, you won’t owe the penalty. You can achieve this by enrolling in the next General Enrollment Period (GEP), which runs from January 1 to March 31 each year.
  • You won’t owe the penalty if you delayed enrolling in Medicare Part A and Part B at age 65. This is because you must have Part and Part B to enroll in Part D and therefore, you were not eligible for Part D.
  • You qualify for special enrollment if you live abroad. You won’t owe the penalty if you enroll in Part D within three months of returning to the US.
  • You may be able to ask for a “reconsideration” if you find out you owe a penalty after you enroll in a drug plan. Your drug plan will send you information about how to request a reconsideration.

Citations: Avoid late enrollment penalties. Medicare.Gov. What are exceptions to the Part A late enrollment penalty?. AARP.Org. How much is the late-enrollment penalty for Medicare Part B?. AARP.Org. What is the Medicare Part D late enrollment penalty?. AARP.Org.

Thomas DeMichele

Thomas DeMichele

Thomas DeMichele has worked in the online health insurance information space for over a decade. His works include ObamaCareFacts.com, which has been used by nearly 40 million Americans since 2012 to learn about healthcare and health insurance.

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