Part D Late Enrollment Penalty Calculations

If you don’t buy Part D Rx when you are supposed to, there is a late enrollment  penalty of 12%/year when you finally do.  Part D became available in 1.2006 Wikipedia.   See also  Medicare & YouPart D Rx Guide,  Medicare.Gov for more details.

The late enrollment penalty is an amount that’s added to your Part D 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 Part D or other creditable prescription drug coverage. See “Medicare and you #10050” for an introduction to the LEP, Late Enrollment Penalty. Currently, the late enrollment penalty is calculated by multiplying 1% of the national base beneficiary premium ($35.63 in 2017) times the number of full, uncovered months that you were eligible (Residence) but didn’t join a Medicare drug plan and went without other creditable prescription drug coverage.

Consumer Links

Part D Prescription Drug Guide #11109 84 pages pdf

Medicare & You – See link in Side Panel

Explanation on Medicare’s Website

How to avoid penalty

Part D Late Enrollment Penalty Reconsideration Request Form Appeals-and-Grievances/

Part D Rx 42 USC §1395 Late Enrollment Penalty on Cornell Law Website

Part D Late Enrollment Penalty Calculator  

Q & A

I am 75. When Part D became available I did not enroll because I found another supplier at a substantial discount. If I understand the program, I am now subject to a 1% per month penalty from the date I became eligible to join Part D or in my case about a 50% penalty on the premium cost. Can this be so? Of course when it comes to the U.S. government stupid is the norm. Lately I have found that as Generics become available, I can switch back to purchasing them at Costco at substantial discount.

So what happened to the $ 31.80 you quoted earlier?

I did not quote that. It’s from the Official Medicare Manual. “national base beneficiary premium” ($31.08 in 2012) Or was that the low premium in 2006?It changes ($32.34 in 2011) See the links below.

And on which the 1% is being calculated?

$31.08 Now it appears we are at $ 54.82 p/m or $657.84 per year for the “Standard” plan.  Math sounds close. The answer to the annual income from regular taxable earnings is less than $ 170,000.00. The good side is you do not have that “extra” tax. Can this figure be relied upon and have premiums increased by 19% since 2006?The penalty is only for the period of time that you have not been covered. So, it’s $15 forever.

On the other hand… Since the “national base beneficiary premium” may increase each year, the penalty amount may also increase every year. You may have to pay this penalty for as long as you have a Medicare drug plan. More Info. (Unfortunately, it says the exact same thing)

At 06:07 PM 4/30/2012,  Is that $ 31.08 X 50 months X 1% penalty per month = $ 15.52 for a total monthly premium of $ 47.34??????

***My numbers do not quite match, but the concept is correct. It would be $15.52 on top of what ever premium you choose. Do you and your wife have more than $170k in income?

If I understand the program, I am now subject to a 1% per month penalty from the date I became eligible to join Part D or in my case about a 50% penalty on the premium cost. Can this be so?

***2006 Effective Date = 50 months x ($31,08/1%) = $15/month penalty

Medicare and You 2020 #10050  
Everything you want to know 

Medicare and you

Different Parts of Medicare 

A = Hospital
B = Doctor Visits - Out Patient
C = Medicare Advantage or Medi Gap
D = Part D Rx


Understanding your Medicare Choices
Medi Gap vs Medicare Advantage


How to sign up for Parts A & B
Is  your test, service, or item covered?
Original Medicare Parts A & B
Medicare Advantage Plans & Part D Rx
Supplement Insurance (Medigap)
Low Income Help  LIS

Enroll in Blue Cross

Enroll in Blue Shield 

Don't like computers?
Prefer a printed version be mailed to you?
Audio MP 3

Use our scheduler to Set a phone, Skype or Face to Face meeting
Intake Form - We can better prepare for the meeting

Set a phone, Skype or Face to Face Meeting to review your quotes, needs & wants.

10 comments on “Late Enrollment Penalty – Calculations

  1. Part D Rx Prescriptions is included at no additional charge with my Medicare Advantage Plan, right? So, why do they charge me a late enrollment penalty?

  2. Social Security sent me a letter that I might get a late enrollment penalty as they don’t think I had credible employer coverage.

    How do I show them that I did?

    • From what I gather, your PDP Rx Carrier, should send you a “Declaration of Prior Prescription Drug Coverage” Exhibit # 1 D

      If you have further questions, you might try contacting:

      Rhonda GreeneBruce via e-mail at [email protected] or via telephone at (410) 786-7579

      What if I have questions?
      If you have questions about the information in this form or the late
      enrollment penalty [or would like to complete this form over the telephone],
      call your Medicare drug plan.

      You may also contact Medicare:
      • Visit on the web
      • Call 1-800-MEDICARE (1-800-633-4227)
      • TTY users call 1-877-486-2048.

      • I filled out the declaration and sent it to AARP – Symponex – A month ago April 11th. I haven’t heard from anyone. What’s the problem? Should I worry?

        • Unfortunately, IMHO AARP and Medicare.Gov think that they are the be all and end all in customer service and that brokers don’t add much to the equation. That is, they only pay brokers $50 1st year and $25 for renewal to help the public with the confusion they create. I blame it mostly on Medicare, with all their rules. On the other hand, considering the subsidies the Government is giving, I guess that entitles them a lot of control!

          The best answer I’ve rec’d is for the member – customer to wait on hold and talk to customer service:

          AARP Part D Customer Service at 1 (888) 867-5575

          Personally, I wouldn’t worry till I heard something.

  3. I am being charged a late enrolment penalty and feel this is unjustified.

    Please tell me what the very earliest date of Medicare Part D enrollment, year and month?

  4. Is there any way for us to Participate in Part “D” without paying the penalty for late filing [not enrolling when we were first eligible – 5.15.2006]?

Leave a Reply

Your email address will not be published. logo