Part D Late Enrollment Penalty

Appeals are handled by Maximus as a Federal Contractor.

Just fill out the form and wait…

Part D Late Enrollment Penalty Reconsideration Request Form 

If you are being charged a Late Enrollment Penalty (LEP), you may request an LEP Reconsideration appeal with MAXIMUS Federal Services, the Part D Qualified Independent Contractor. 

An enrollee may use this form to request an appeal of a Late Enrollment Penalty decision. The enrollee must complete the form, above, sign it, and send it to the Independent Review Entity – Maximus as instructed in the form.  CMS.gov *

Appointment of Representative Form (CMS-1696)

Please be sure to read our main page on the penalities for late enrollment in Part D, so that you understand how and what Maximus is looking for you to prove in an appeal.

Email: [email protected]

www.MedicarePartDAppeals.com

Frequently-asked-questions  Part D in General

I have been told by my plan that I owe a penalty for enrolling late in the Medicare Prescription Drug Program. I do not think that this is correct.

How do I file an appeal?

Reconsideration Process Manual   I don’t see anything about LEP though

maximus
Maximus Appeals – Information

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 

Video

Understanding your Medicare Choices
Medi Gap vs Medicare Advantage

Topics

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
Definitions


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

MEDICARE PRESCRIPTION DRUG
BENEFIT MANUAL
CHAPTER 4 Creditable Coverage Period
Determinations and the Late Enrollment Penalty

Creditable Coverage Period Determinations and the Late Enrollment Penalty

14 comments on “Maximus Appeals LEP Late Enrollment Penalty

  1. I signed up with Aetna Medicare Advantage Plan ($0 premium) starting June 1, 2019.

    I submitted a Declaration of prior prescription drug coverage form stating I had prior drug coverage from 6/1/2018 to 5/31/2019.

    Yesterday I received a premium payment book from Aetna to make payments to them.

    I was told I need to send in an appeal and they or the government wants to know if I had coverage from July 2017 to May 2018 (which I did with Blue Cross).

    I downloaded the “Part D Enrollment Penalty Reconsideration Request Form.

    Our office person is out all week so I can’t provide a copy of Notice of Creditable prescription Drug Coverage.

    So what can I do?

    This is really a pain to deal with.

  2. I never received a call from Maximus.

    I need to prepare explanation in reference to late enrollment

    • Judging from the information I’ve researched and put on this page, I don’t think Maximus will help you. All I can say is complete the forms to the best of your ability and send them in. Be sure to read all the instructions and if you want to do even better, the relevant information on this page and your own research. You might ask your agent/broker for help. You might also check with legal counsel, but there probably isn’t enough money involved.

      You might try HICAP in your state https://www.shiptacenter.org/

      Here’s CA’s website https://cahealthadvocates.org/

  3. I retired in January 2018, at age 71.

    I’ve had Part D coverage from Company A from February 2018 through December 2018. Then I switched companies and enrolled with Company B. In Company B’s welcome letter, they said that my premium included a large late enrollment penalty, which they were basing on information from Company A.

    When I called both Company A and Medicare, I found that they were charging me a penalty based on the period from when I turned 65, in 2011, to when I enrolled in Company A, in 2018.

    But I was working during that time and had creditable drug coverage through my employer. Now I’ve obtained a Disclosure of Creditable Coverage for that period.

    I never noticed that Company A’s premium included a penalty. I don’t even know if they told me. But I think it’s too late to recover from Company A, and I’m OK with that.

    What I’d like is for the penalty to stop now and in the future.

    To get this done, is it enough to file a reconsideration request with Maximus, sending them my Disclosure and my enrollment letter from Company B? Or must I do something more?

    • I searched and searched – I don’t see anything else for you to do, besides complete the form and wait.

      I’d go ahead and ask for all your $$$ back.

      Here’s what the reconsideration form says:

      If it has been more than 60 days, explain your reason for delay on a separate sheet and send it with this form

      • I thought I should let you know how this turned out. I submitted this same question to the government site’s chat feature (mymedicare.gov) and the representative could also think of nothing to do except to file the Maximus paperwork, including my Disclosure of Creditable Coverage. She thought that if my appeal was approved, I might send a letter to Company A asking for my LEP back.

        So I just filed the appeal, with my creditable coverage paper. I did not include any notes about the “reason for [my] delay,” since this feature seems to be about things like being too sick to file paperwork, not things like not noticing that you were paying a penalty.

        But it turned out well. A couple of days ago, I got a letter from Maximus that begins “The appeal decision is FAVORABLE [all caps in original].” The letter says that “[t]he Part D plan must report a revised creditable coverage period determination indicating zero (0) uncovered months to Centers for Medicare & Medicaid (CMS) …” It also says that they are telling the plans “listed below” to reimburse my LEP, and this list includes both Company B and Company A.

        So this is a happy ending, probably. I say “probably” for several reasons. First, it took them two months to reply and I still haven’t heard about my wife’s appeal, which I filed separately. She had creditable coverage as my dependent, so the same Disclosure applies to her. Second, I haven’t heard from either Company A or Company B about reimbursing me. But since I never really expected reimbursement, this is not important.

        I’m now pretty confident that things will turn out well. Thanks for your help.

  4. I have tried to find help from every Provider and Hospital I have experienced. I do not belong in the LEP program I was told to demand a refund my Medicare UHC or AARP that has been taking my money more than 86 months. I’ve been Employed since 8/96.

    I have been charged more than 90 times for the LEP. Presently I remain on disability and have been since the age of 49. I have called United Health Care going on years in addition to Medicare. Last week they show me with not fitting into that category. At this point I demand a rebate or good reason this mistake continues. Call Medicare that show I do not belong in the LEP group. I was On Medicare and covered by several RX plans until today. I have been abused by your system and a lot of money taken with no good reason. AARP Medicare has been charging a fee as long as I remember. Washington University has always covered me since 6/1986 when Rx programs were not offered. Please refund me the 86 plus payments and the ones you have charged me in error.

    • The proper venue to ask for your LEP to end, file an appeal, apply for a refund is with Maxiumus http://www.medicarepartdappeals.com/ not this website. We are providing information only and if you want coverage for 2019 we can help you get that.

      Please provide a certificate of credible coverage

      Prescription drug coverage (for example, from an employer or union) that’s expected to pay, on average, at least as much as Medicare’s standard prescription drug coverage. People who have this kind of coverage when they become eligible for Medicare can generally keep that coverage without paying a penalty, if they decide to enroll in Medicare prescription drug coverage later.

      from Washington University showing that you’ve had coverage at least as good as the standard part d program.

      Be sure to read all the information * Medicare & You * Your Guide to Medicare Rx * on the Part D LEP so that you know how to present your case and in the proper venue, not in comments on this site.

      Here’s a sample notice of credible coverage. This is what you must show to Maximus. Without it, your just spinning your wheels.

      Here’s the Part D Late Enrollment Penalty (LEP) Reconsideration Request Form that gets filled out and sent to Maximus.

  5. I am being penalized for late enrollment

    I retired 2 years ago April I was fully insured until that time I don’t know how this could be.

    I need help with this I have been paying this extra fee for about 2 years now.

    • Do you have proof of Creditable Coverage from your employer?

      Creditable prescription drug coverage—Prescription drug coverage (for example, from an employer or union) that’s expected to pay, on average, at least as much as Medicare’s standard prescription drug coverage. People who have this kind of coverage when they become eligible for Medicare can generally keep that coverage without paying a penalty, if they decide to enroll in Medicare prescription drug coverage later. Learn More ==> Guide to Medicare Rx Page 83

Leave a Reply

Your email address will not be published.

wp-puzzle.com logo